bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPLEMENTATION METHOD ON MEDICAL IMAGE COMPRESSION SYSTEM: A REVIEW
Authors: Muharam Azlan , Ahmad Afandi
Published: October 2017

The rapid development of medical imaging and the invention of various medicines have benefited mankind and the whole community. Medical image processing is a niche area concerned with the operations and processes of generating images of the human body for clinical purposes.  Potential areas such as image acquisition, image enhancement, image compression and storage, and image based visualization also include in medical image processing analysis. Unfortunately, medical image compression dealing with three-dimensional (3-D) modalities still in the pre-matured stage. Along with that, very limited researchers take a challenge to apply hardware on their implementation. Referring to the previous work reviewed, most of the compression method used lossless rather than lossy. For implementation using software, MATLAB and Verilog are the famous candidates among researchers. In term of analysis, most of the previous works conducted objective test compared with subjective test. This paper thoroughly reviews the recent advances in medical image compression mainly in terms of types of compression, software and hardware implementations and performance evaluation. Furthermore, challenges and open research issues are discussed in order to provide perspectives for future potential research. In conclusion, the overall picture of the image processing landscape, where several researchers more focused on software implementations and various combinations of software and hardware implementation.
EXPERIMENTAL STUDY AND HIGH DIMENSIONAL QSAR MODELLING OF PHENYLPROPANOIDS OF ALPINIA GALANGA AS CORROSION INHIBITORS ON MILD STEEL
Authors: Ajeigbe Sunday O. , Basar Norazah , Y. Algamal Zakariya , H. Lee Muhammad , Maarof Hasmerya , Aziz Madzlan
Published: October 2017

Plant extracts as corrosion inhibitors have been extensively investigated and are found as an alternative to synthetic organic compounds. The corrosion inhibition of mild steel in 1 M HCl by 15 compounds comprising of five phenylpropanoids from Alpinia galanga and other related compounds was explored experimentally using potentiodynamic polarisation procedures. The inhibition efficiencies determined experimentally for the various inhibitors were used in the Quantitative Structure-Activity Relationship (QSAR) study with their molecular descriptors calculated using Dragon software. Penalised multiple linear regression (PMLR) was adopted as the method of variable selection using elastic net penalty. The elastic net results show low mean-squared error of the training set (MSEtrain) of 0.121 and test set (MSEtest) of 0.131. The model obtained can be applied to predict the corrosion inhibition efficiencies of related organic compounds. Results also reveal that the PMLR based on elastic net penalty is effective in dealing with high dimensional data.
Fan Similarity Model for the Fan–Intake Interaction Problem
Authors: Carnevale Mauro , Wang Feng , Parry Anthony B. , Green Jeffrey S. , di Mare Luca
Published: October 2017

Very high bypass ratio turbofans with large fan tip diameter are an effective way of improving the propulsive efficiency of civil aero-engines. Such engines, however, require larger and heavier nacelles, which partially offset any gains in specific fuel consumptions. This drawback can be mitigated by adopting thinner walls for the nacelle and by shortening the intake section. This binds the success of very high bypass ratio technologies to the problem of designing an intake with thin lips and short diffuser section, which is well matched to a low speed fan. Consequently, the prediction of the mutual influence between the fan and the intake flow represents a crucial step in the design process. Considerable effort has been devoted in recent years to the study of models for the effects of the fan on the lip stall characteristics and the operability of the whole installation. The study of such models is motivated by the wish to avoid the costs incurred by full, three-dimensional (3D) computational fluid dynamics (CFD) computations. The present contribution documents a fan model for fan–intake computations based on the solution of the double linearization problem for unsteady, transonic flow past a cascade of aerofoils with finite mean load. The computation of the flow in the intake is reduced to a steady problem, whereas the computation of the flow in the fan is reduced to one steady problem and a set of solutions of the linearized model in the frequency domain. The nature of the approximations introduced in the fan representation is such that numerical solutions can be computed inexpensively, while the main feature of the flow in the fan passage, namely the shock system and an approximation of the unsteady flow encountered by the fan are retained. The model is applied to a well-documented test case and compares favorably with much more expensive 3D, time-domain computations.
Design of a Contact-Aided Compliant Notched-Tube Joint for Surgical Manipulation in Confined Workspaces
Authors: Eastwood Kyle W. , Francis Peter , Azimian Hamidreza , Swarup Arushri , Looi Thomas , Drake James M. , Naguib Hani E.
Published: October 2017

This work presents a novel miniature contact-aided compliant joint mechanism that can be integrated into millimeter-sized manual or robotic surgical instruments. The design aims to address the trade-off between notched-tube compliant joints' range of motion and stiffness, while also ensuring a compact form factor. The mechanism is constructed from a nitinol tube with asymmetric cutouts and is actuated in bending by a cable. The innovative feature of this design is the incorporation of a contact aid into the notched-tube topology, which acts to both increase the stiffness of the joint and change the shape that it undertakes during bending. Using finite element modeling (FEM) techniques, we present a sensitivity analysis investigating how the performance of this contact-aided compliant mechanism (CCM) is affected by its geometry, and derive a kinematics and statics model for the joint. The FEM simulations and the kinematic and static models are compared to experimental results. The design and modeling presented in this study can be used to develop new miniature dexterous instruments, with a particular emphasis on applications in minimally invasive neurosurgery.
Fabrication and pixel characterization of a row-column addressable 128 × 128 InAs/GaSb type-II superlattice midwave infrared photodiode array
Authors: Das Sona , Das Utpal
Published: October 2017

A row-column addressable 128 × 128 InAs/GaSb type-II superlattice midwave infrared photodiode array of 8 μm square pixels with 2 μm interpixel separation is fabricated with SU-8 polymer isolation after reactive ion etching pixel delineation. The dark current of the mesa etched + SU-8 passivated 8 × 8 μm2 pixel is found to be ∼800 nA at an applied reverse bias voltage, V = 0.3 V. The photoresponse of the same 8 μm square pixel under 2 ns pulsed condition shows a peak responsivity of ∼0.03 A/W at λ ∼ 3.8 μm at a temporal width of ∼ 6 ns. This enables integration of the photodiode array with a winner-takes-all read out circuit for high speed tracking applications.
Sound attenuation optimization using metaporous materials tuned on exceptional points
Authors: Xiong Lei , Nennig Benoit , Aurégan Yves , Bi Wenping
Published: October 2017

A metamaterial composed of a set of periodic rigid resonant inclusions embedded in a porous lining is investigated to enhance the sound attenuation in an acoustic duct at low frequencies. A transmission loss peak is observed on the measurements and corresponds to the crossing of the lower two Bloch modes of an infinite periodic material. Numerical parametric studies show that the optimum modal attenuation can be achieved at the exceptional point in the parameter plane of inclusion position and frequency, where the two lower modes merge.
Electrically driven monolithic subwavelength plasmonic interconnect circuits
Authors: Liu Yang , Zhang Jiasen , Liu Huaping , Wang Sheng , Peng Lian-Mao
Published: October 2017

Here, we experimentally demonstrate a monolithic, subwavelength plasmonic interconnect circuit.
Transforming from planar to three-dimensional lithium with flowable interphase for solid lithium metal batteries
Authors: Liu Yayuan , Lin Dingchang , Jin Yang , Liu Kai , Tao Xinyong , Zhang Qiuhong , Zhang Xiaokun , Cui Yi
Published: October 2017

Improving the performance of solid-state lithium metal battery with three-dimensional anode nanostructural design.
Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial
Authors: McAllister Jan , Gascoine Sally , Carroll Amy , Humby Kate , Kingston Mary , Shepstone Lee , Risebro Helen , Mackintosh Bundy , Thompson Tammy Davidson , Hodgekins Jo
Published: October 2017

Objective

To determine the feasibility and acceptability of a computerised treatment for social anxiety disorder for adults who stutter including identification of recruitment, retention and completion rates, large cost drivers and selection of most appropriate outcome measure(s) to inform the design of a future definitive trial.

Design

Two-group parallel design (treatment vs placebo), double-blinded feasibility study. Participants: 31 adults who stutter.

Intervention

Attention training via an online probe detection task in which the stimuli were images of faces displaying neutral and disgusted expressions.

Main outcome measures

Psychological measures: Structured Clinical Interview Global Assessment of Functioning score; Liebowitz Social Anxiety Scale; Social Phobia and Anxiety Inventory; State-Trait Anxiety Inventory; Unhelpful Thoughts and Beliefs about Stuttering. Speech fluency: percent syllables stuttered. Economic evaluation: resource use questionnaire; EuroQol three-dimension questionnaire.

Acceptability: Likert Scale questionnaire of experience of trial, acceptability of the intervention and randomisation procedure.

Results

Feasibility of recruitment strategy was demonstrated. Participant feedback indicated that the intervention and definitive trial, including randomisation, would be acceptable to adults who stutter. Of the 31 participants who were randomised, 25 provided data at all three data collection points.

Conclusions

The feasibility study informed components of the intervention. Modifications to the design are needed before a definitive trial can be undertaken.

Trial registration number

I SRCTN55065978; Post-results.
What are the associations between neighbourhood walkability and sedentary time in New Zealand adults? The URBAN cross-sectional study
Authors: Hinckson Erica , Cerin Ester , Mavoa Surzanne , Smith Melody , Badland Hannah , Witten Karen , Kearns Robin , Schofield Grant
Published: October 2017

Objectives

We estimated associations between objectively determined neighbourhood ‘walkability’ attributes and accelerometer-derived sedentary time (ST) by sex, city or type of day.

Design

A cross-sectional study.

Setting

The URBAN (Understanding the Relationship between Activity and Neighbourhoods) study was conducted in 48 neighbourhoods across four cities in New Zealand (August 2008 to October 2010).

Participants

The response rate was 41% (2029 recruited participants/5007 eligible households approached). In total, 1762 participants (aged 41.4±12.1, mean±SD) met the data inclusion criteria and were included in analyses.

Primary and secondary outcome measures

The exposure variables were geographical information system (GIS) measures of neighbourhood walkability (ie, street connectivity, residential density, land-use mix, retail footprint area ratio) for street network buffers of 500 m and 1000 m around residential addresses. Participants wore an accelerometer for 7 days. The outcome measure was average daily minutes of ST.

Results

Data were available from 1762 participants (aged 41.4±12.1 years; 58% women). No significant main effects of GIS-based neighbourhood walkability measures were found with ST. Retail footprint area ratio was negatively associated with sedentary time in women, significant only for 500 m residential buffers. An increase of 1 decile in street connectivity was significantly associated with a decrease of over 5 min of ST per day in Christchurch residents for both residential buffers.

Conclusion

Neighbourhoods with proximal retail and higher street connectivity seem to be associated with less ST. These effects were sex and city specific.
Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: results from the SLE.E.P.Y cohort study
Authors: Pedrotti Emilio , Demasi Christian Luigi , Bruni Enrico , Bosello Francesca , Di Sarro Paolo Plinio , Passilongo Mattia , Fasolo Adriano , Gennaro Nicola , De Gregorio Alessandra , Ferrari Marcello , Marchini Giorgio
Published: October 2017

Objectives

To assess the occurrence of glaucoma, eyelid, corneal and macular disorders in a cohort of patients with obstructive sleep apnoea (OSA) diagnosed by overnight polysomnography and to investigate into the risk factors for the above eye diseases (EDs).

Design

Cross-sectional cohort study between 2014 and 2015.

Setting

Unit of Respiratory Medicine and Eye Clinic of the University of Verona.

Participants

431 consecutive patients were considered eligible. Of these, 87 declined to participate, 35 were untraceable and 13 were deceased.

Interventions

A complete ophthalmic evaluation of both eyes for each patient.

Primary and secondary outcome measures

Best-corrected distance visual acuity, intraocular pressure, corneal, macular and optic nerve optical coherence tomography, ocular aberrometry, optic nerve laser polarimetry, visual field test, and eyelid examination.

Results

296 patients aged 64.5±12.8 years, 23% female and 77% male, underwent ophthalmic examination. There was 56% (n=166) prevalence of eyelid disorders, 27% (n=80) of corneal disorders, 13% (n=39) of macular disorders and 11% (n=33) of glaucoma. Advancing age was not associated with the severity of OSA, while significant differences were found for gender, body mass index, Oxygen Desaturation Index, smoking habit, hypertension and diabetes. Severe OSA was significantly associated with glaucoma (OR, 95% CI 1.05 to 5.93, p=0.037).

Conclusions

EDs were more prevalent in our patinets with OSA than in the general population. Severe Apnoea/Hypopnoea Index level seemed to play a role as risk factor only for glaucoma.
Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial
Authors: Li Ting , Yeung Joyce , Li Jun , Zhang Yan , Melody Teresa , Gao Ye , Wang Yi , Lian Qianquan , Gao Fang
Published: October 2017

Introduction

Postoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery.

Methods and analysis

RAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery. A total of 1000 patients who are 65 years or over and who are having planned hip fracture surgery in nine clinical trial centres of China will be randomised in a 1:1 ratio to receive either anaesthesia for the surgery. The primary endpoint will be the incidence of POD at day 7. The secondary endpoints will be the subtype, severity and duration of delirium, postoperative acute pain score, incidence of other postoperative non-delirium complications, quality of life and cost-effective outcomes. Randomisation will be performed at the patient level using computer-generated assignment. Outcome assessors will be blinded from intervention assignment. Assessments will be conducted before surgery, intraoperatively, postoperatively, during the hospital stay, at 30-day, 6-month and 1-year postoperative intervals.

Potential impact of study

This study will provide clinical evidence with a more robust methodology to help anaesthetists in selecting appropriate anaesthesia for older patients with high risk for POD. At the era of increasing emphasis on delirium prevention, this trial has the potential to inform the future national guideline to reduce POD.

Ethics and dissemination

Ethical approved by the local institutional review board. Trial results will be presented at national and international academic conferences, and published in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov (NCT02213380); pre-results.
Impact of child summertime obesity interventions on body mass index, and weight-related behaviours: a systematic review and meta-analysis protocol
Authors: Moreno Jennette P , Vézina-Im Lydi-Anne , Vaughan Elizabeth M , Baranowski Tom
Published: October 2017

Introduction

In previous studies, it has been found that on average, children consistently gained weight during the summer months at an increased rate compared with the 9-month school year. This contributed to an increased prevalence of overweight and obesity in children. Several obesity-related interventions have occurred during or targeting the summer months. We propose to conduct a systematic review and meta-analysis of the impact of obesity prevention and treatment interventions for school-age children conducted during the summer or targeting the summer months when children are not in school on their body mass index (BMI), or weight-related behaviours.

Methods and analyses

A literature search will be conducted by the first author (JPM) using MEDLINE/PubMed, Cochrane Library, Scopus, CINAHL, PsycINFO, EMBASE and Proquest Dissertations and Theses databases from the date of inception to present. Studies must examine interventions that address the modification or promotion of weight-related behaviours (eg, dietary patterns, eating behaviours, physical activity (PA), sedentary behaviour or sleep) and target school-age children (ages 5–18). The primary outcomes will be changes from baseline to postintervention and/or the last available follow-up measurement in weight, BMI, BMI percentile, standardised BMI or per cent body fat. Secondary outcomes will include changes in dietary intake, PA, sedentary behaviour or sleep. Risk of bias will be assessed using the Cochrane risk of bias tool for randomised and non-randomised studies, as appropriate.

Ethics and dissemination

Because this is a protocol for a systematic review, ethics approval will not be required. The findings will be disseminated via presentations at scientific conferences and published in a peer-reviewed journal. All amendments to the protocol will be documented and dated and reported in the PROSPERO trial registry.

PROSPERO registration number

CRD42016041750
Secondary analysis of frequency, circumstances and consequences of calculation errors of the HEART (history, ECG, age, risk factors and troponin) score at the emergency departments of nine hospitals in the Netherlands
Authors: Ras Marten , Reitsma Johannes B , Hoes Arno W , Six Alfred Jacob , Poldervaart Judith M
Published: October 2017

Objective

The HEART score can accurately stratify the risk of major adverse cardiac events (MACE) in patients with chest pain. We investigated the frequency, circumstances and potential consequences of errors in its calculation.

Methods

We performed a secondary analysis of a stepped wedge trial of patients with chest pain presenting to nine Dutch emergency departments. We recalculated HEART scores for all patients by re-evaluating the elements age (A), risk factors (R) and troponin (T) and compared these new scores with those given by physicians in daily practice. We investigated which circumstances increased the probability of incorrect scoring and explored the potential consequences.

Results

The HEART score was incorrectly scored in 266 out of 1752 patients (15.2%; 95% CI 13.5% to 16.9%). Most errors occurred in the R (‘Risk factors’) element (61%). Time of admission, and patient’s age or gender did not contribute to errors, but more errors were made in patients with higher scores. In 102 patients (5.8%, 95% CI 4.7% to 6.9%) the incorrect HEART score resulted in incorrect risk categorisation (too low or too high). Patients with an incorrectly calculated HEART score had a higher risk of MACE (OR 1.85; 95% CI 1.37 to 2.50), which was largely related to more errors being made in patients with higher HEART scores.

Conclusions

Our results show that the HEART score was incorrectly calculated in 15% of patients, leading to inappropriate risk categorisation in 5.8% which may have led to suboptimal clinical decision-making and management. Actions should be taken to improve the score’s use in daily practice.
Critical Care Cycling Study (CYCLIST) trial protocol: a randomised controlled trial of usual care plus additional in-bed cycling sessions versus usual care in the critically ill
Authors: Nickels Marc R , Aitken Leanne M , Walsham James , Barnett Adrian G , McPhail Steven M
Published: October 2017

Introduction

In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown.

Methods and analysis

A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions. The primary outcome is change in rectus femoris cross-sectional area at day 10 in comparison to baseline measured by blinded assessors. Secondary outcome measures include muscle strength, incidence of ICU-acquired weakness, handgrip strength, time to achieve functional milestones (sitting out of bed, walking), Functional Status Score in ICU, ICU Mobility Scale, 6 min walk test 1 week post-ICU discharge, incidence of delirium and quality of life (EuroQol Five Dimensions questionnaire Five Levels scale). Quality of life assessments will be conducted post-ICU admission at day 10, 3 and 6 months after acute hospital discharge. Participants in the intervention group will complete an acceptability of intervention questionnaire.

Ethics and dissemination

Appropriate ethical approval from Metro South Health Human Research Ethics Committee has been attained. Results will be published in peer-reviewed publications and presented at scientific conferences to assist planning of future multicentre randomised controlled trials (if indicated) that will test in-bed cycling as an intervention to improve the physical, cognitive and health-related quality of life outcomes of patients with critical illness.

Trial registration number

This trial has been prospectively registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12616000948493); Pre-results.
A scoping review protocol on the roles and tasks of peer reviewers in the manuscript review process in biomedical journals
Authors: Glonti Ketevan , Cauchi Daniel , Cobo Erik , Boutron Isabelle , Moher David , Hren Darko
Published: October 2017

Introduction

The primary functions of peer reviewers are poorly defined. Thus far no body of literature has systematically identified the roles and tasks of peer reviewers of biomedical journals. A clear establishment of these can lead to improvements in the peer review process. The purpose of this scoping review is to determine what is known on the roles and tasks of peer reviewers.

Methods

We will use the methodological framework first proposed by Arksey and O’Malley and subsequently adapted by Levacet aland the Joanna Briggs Institute. The scoping review will include all study designs, as well as editorials, commentaries and grey literature. The following eight electronic databases will be searched (from inception to May 2017): Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science. Two reviewers will use inclusion and exclusion criteria based on the ‘Population–Concept–Context’ framework to independently screen titles and abstracts of articles considered for inclusion. Full-text screening of relevant eligible articles will also be carried out by two reviewers. The search strategy for grey literature will include searching in websites of existing networks, biomedical journal publishers and organisations that offer resources for peer reviewers. In addition we will review journal guidelines to peer reviewers on how to perform the manuscript review. Journals will be selected using the 2016 journal impact factor. We will identify and assess the top five, middle five and lowest-ranking five journals across all medical specialties.

Ethics and dissemination

This scoping review will undertake a secondary analysis of data already collected and does not require ethical approval. The results will be disseminated through journals and conferences targeting stakeholders involved in peer review in biomedical research.
Identifying and sharing data for secondary data analysis of physical activity, sedentary behaviour and their determinants across the life course in Europe: general principles and an example from DEDIPAC
Authors: Lakerveld Jeroen , Loyen Anne , Ling Fiona Chun Man , De Craemer Marieke , van der Ploeg Hidde P , O’Gorman Donal J , Carlin Angela , Caprinica Laura , Kalter Joeri , Oppert Jean-Michel , Chastin Sebastian , Cardon Greet , Brug Johannes , MacDonncha Ciaran
Published: October 2017

Background

The utilisation of available cross-European data for secondary data analyses on physical activity, sedentary behaviours and their underlying determinants may benefit from the wide variation that exists across Europe in terms of these behaviours and their determinants. Such reuse of existing data for further research requires Findable; Accessible; Interoperable; Reusable (FAIR) data management and stewardship. We here describe the inventory and development of a comprehensive European dataset compendium and the process towards cross-European secondary data analyses of pooled data on physical activity, sedentary behaviour and their correlates across the life course.

Methods

A five-step methodology was followed by the European Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, covering the (1) identification of relevant datasets across Europe, (2) development of a compendium including details on the design, study population, measures and level of accessibility of data from each study, (3) definition of key topics and approaches for secondary analyses, (4) process of gaining access to datasets and (5) pooling and harmonisation of the data and the development of a data harmonisation platform.

Results

A total of 114 unique datasets were found for inclusion within the DEDIPAC compendium. Of these datasets, 14 were eventually obtained and reused to address 10 exemplar research questions. The DEDIPAC data harmonisation platform proved to be useful for pooling, but in general, harmonisation was often restricted to just a few core (crude) outcome variables and some individual-level sociodemographic correlates of these behaviours.

Conclusions

Obtaining, pooling and harmonising data for secondary data analyses proved to be difficult and sometimes even impossible. Compliance to FAIR data management and stewardship principles currently appears to be limited for research in the field of physical activity and sedentary behaviour. We discuss some of the reasons why this might be the case and present recommendations based on our experience.
Future trends in the prevalence of severe activity limitations among older adults in Europe: a cross-national population study using EU-SILC
Authors: Scherbov Sergei , Weber Daniela
Published: October 2017

Objective

To project the proportion of population 65+ years with severe long-term activity limitations from 2017 to 2047.

Design

Large population study.

Setting

Population living in private households of the European Union (EU) and neighbouring countries.

Participants

Participants from the EU Statistics on Income and Living Conditions aged 55 years and older and living in one of 26 EU and neighbouring countries, who answered the health section of the questionnaire.

Outcome measures

Prevalence of severe long-term activity limitations of particular subpopulations (ie, 55+, 65+, 75+ and 85+ years) by sex and country.

Results

We find a huge variation in the prevalence of self-reported severe long-term limitations across Europe for both sexes. However, in 2017, about 20% of the female population aged 65 years and above and about 16% of their male counterparts are expected to report severe long-term activity limitations after accounting for differences in reporting. Accounting for cultural differences in reporting, we expect that European countries will have about 21% (decile 1: 19.5%; decile 9: 22.9%) of female and about 16.8% (decile 1: 15.4%; decile 9: 18.1%) of male 65+ years population with severe long-term activity limitations by 2047.

Conclusions

Overall, despite the expected increase of life expectancy in European countries, our results suggest almost constant shares of older adults with severe long-term activity limitations within the next 30 years.
Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods
Authors: Thompson Rachel , Manski Ruth , Donnelly Kyla Z , Stevens Gabrielle , Agusti Daniela , Banach Michelle , Boardman Maureen B , Brady Pearl , Colón Bradt Christina , Foster Tina , Johnson Deborah J , Li Zhongze , Norsigian Judy , Nothnagle Melissa , Olson Ardis L , Shepherd Heather L , Stern Lisa F , Tosteson Tor D , Trevena Lyndal , Upadhya Krishna K , Elwyn Glyn
Published: October 2017

Introduction

Despite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods.

Methods and analysis

We will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt cardanddecision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15–49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later.

Ethics and dissemination

We will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes.

Trial registration number

ClinicalTrials.gov Identifier:NCT02759939.
A longitudinal study to assess the frequency and cost of antivascular endothelial therapy, and inequalities in access, in England between 2005 and 2015
Authors: Hollingworth William , Jones Tim , Reeves Barnaby C , Peto Tunde
Published: October 2017

Objectives

High-cost antivascular endothelial growth factor (anti-VEGF) medicines for eye disorders challenge ophthalmologists and policymakers to provide fair access for patients while minimising costs. We describe the growth in the use and costs of these medicines and measure inequalities in access.

Design

Longitudinal study using Hospital Episode Statistics (2005/2006 to 2014/2015) and hospital prescribing cost reports (2008/2009 to 2015/2016). We used Poisson regression to estimate standardised rates and explore temporal and geographical variations.

Setting

National Health Service (NHS) care in England.

Population

Patients receiving anti-VEGF injections for age-related macular degeneration, diabetic macular oedema and other eye disorders.

Interventions

Higher-cost drugs (ranibizumab or aflibercept) recommended by the National Institute for Health and Care Excellence or lower-cost drug (bevacizumab) not licensed for eye disorders.

Main outcome measures

National procedure rates and variation between and within clinical commissioning groups (CCGs). Cost of ranibizumab and aflibercept prescribing.

Results

Injection procedures increased by 215% between 2010/2011 and 2014/2015. In 2014/2015 there were 388 031 procedures (714 per 100 000). There is no evidence that the dramatic growth in rates is slowing down. Since 2010/2011 the estimated cost of ranibizumab and aflibercept increased by 247% to £447 million in 2015/2016, equivalent to the entire annual budget of a CCG. There are large inequalities in access; in 2014/2015 procedure rates in a ‘high use’ CCG were 9.08 times higher than in a ‘low use’ CCG. In the South-West of England there was twofold variation in injections per patient per year (range 2.9 to 5.9).

Conclusions

The high and rising cost of anti-VEGF therapy affects the ability of the NHS to provide care for other patients. Current regulations encourage the increasing use of ranibizumab and aflibercept rather than bevacizumab, which evidence suggests is more cost-effective. NHS patients in England do not have equal access to the most cost-effective care.
Biopsychosocial Intervention for Stroke Carers (BISC): protocol for a feasibility randomised controlled trial (RCT)
Authors: Walker Marion F , Thomas Shirley A , Whitehead Phillip J , Condon Laura , Fisher Rebecca J , Kontou Eirini , Benford Penny , Cobley Christine
Published: October 2017

Introduction

Reducing length of hospital stay for stroke survivors often creates a shift in the responsibility of care towards informal carers. Adjustment to the caregiving process is experienced by many carers as overwhelming, complex and demanding and can have a detrimental impact on mental and physical health and well-being. National policy guidelines recommend that carers’ needs are considered and addressed; despite this, few interventions have been developed and empirically evaluated. We developed a biopsychosocial intervention in collaboration with carers of stroke survivors. Our aim is to determine whether the intervention can be delivered in a group setting and evaluated using a randomised controlled trial (RCT).

Methods and analysis

Feasibility RCT and nested qualitative interview study. We aim to recruit up to 40 stroke carers within 1 year of the stroke onset. Carers are randomised to usual care or usual care plus biopsychosocial intervention. Each intervention group will consist of five stroke carers. The intervention will focus on: psychoeducation, psychological adjustment to stroke, strategies for reducing unwanted negative thoughts and emotions and problem-solving strategies. The main outcome is the feasibility of conducting an RCT. Carer outcomes at 6 months include: anxiety and depression, quality of life and carer strain. Data are also collected from stroke survivors at baseline and 6 months including: level of disability, anxiety and depression, and quality of life.

Ethics and dissemination

Favourable ethical opinion was provided by East Midlands – Nottingham2 Research Ethics Committee (14/EMI/1264). This study will determine whether delivery of the biopsychosocial intervention is feasible and acceptable to stroke carers within a group format. It will also determine whether it is feasible to evaluate the effects of the biopsychosocial intervention in an RCT. We will disseminate our findings through peer-reviewed publications and presentations at national and international conferences.

Trial registration number

ISRCTN15643456; Pre-results.
Drug approval status and recommendations for listing on public formularies: a Canadian cohort analysis
Authors: Lexchin Joel
Published: October 2017

Objectives

Investigate if the recommendations by the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review (pCODR) to provincial, territorial and federal drug plans about whether to list non-oncology and oncology drug-indication combinations on their formularies are associated with whether the drug-indication combination was approved via the standard evidence pathway or the Notice of Compliance with conditions (NOC/c—limited evidence) pathway.

Design

Cohort study.

Data sources

Websites of the CDR and pCODR up to the end of 31 March 2017; journal articles evaluating drugs approved through the NOC/c pathway, the NOC database, the NOC/c website and the Summary Basis of Decision website.

Interventions

Recommendations by the CDR and pCODR.

Primary and secondary outcome measures

Analysis of the percent of drugs receiving positive listing recommendations from CDR and pCODR depending on the pathway used to approve the drug.

Results

There were 310 recommendations for drug-indication combinations from the CDR and 79 from the pCODR. There was a statistically significant difference in the number of drug-indication combinations that received a list versus do not list recommendation from the CDR for those approved through the standard pathway compared with those approved through the NOC/c pathway (p=0.0407). A similar analysis for recommendations from the pCODR was not statistically significant.

Conclusion

For non-oncology drug-indication combinations, the type of review appears to influence the recommendation regarding listing on public formularies. This difference may reflect the level of evidence about the efficacy and safety of the drug indication at the time the recommendation was made.
Factors associated with quality of life in elderly hospitalised patients undergoing post-acute rehabilitation: a cross-sectional analytical study in Switzerland
Authors: Bornet Marc-Antoine , Rubli Truchard Eve , Rochat Etienne , Pasquier Jérôme , Monod Stéfanie
Published: October 2017

Objectives

We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients’ perceived quality of life.

Design

This was a cross-sectional analytical study.

Setting

Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland.

Participants

Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016. Exclusion criteria included significant cognitive disorder and terminal illness. Of 227 eligible participants, complete data were collected from 167.

Main outcome measures

Perceived quality of life was measured using WHO Quality of Life Questionnaire—version for older people. Predictive factors were age, sex, functional status at admission, comorbidities, cognitive status, depressive symptoms, living conditions and satisfaction with care. A secondary focus was the association between spiritual needs and quality of life.

Results

Patients undergoing geriatric rehabilitation experienced a good quality of life. Greater quality of life was significantly associated with higher functional status (rs=0.204, p=0.011), better cognitive status (rs=0.175, p=0.029) and greater satisfaction with care (rs=0.264, p=0.003). Poorer quality of life was significantly associated with comorbidities (rs=−.226, p=0.033), greater depressive symptoms (rs=−.379, p<0.001) and unmet spiritual needs (rs=−.211, p=0.049). Multivariate linear regression indicated that depressive symptoms (β=−0.961; 95% CIs −1.449 to 0.472; p<0.001) significantly predicted quality of life.

Conclusions

Patient perceptions of quality of life were significantly associated with depression. More research is needed to assess whether considering quality of life could improve care plan creation.
Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians
Authors: Sadasivaiah Shobha , Smith David E , Goldman Seth , Ratanawongsa Neda
Published: October 2017

Background

Best possible medication history (BPMH) enhances the care of safety net patients, especially those with limited English proficiency and limited health literacy who are most vulnerable to medication error during the hospital admission process. Our large urban academic safety net centre faced numerous barriers to achieve BPMH among hospitalised patients including communication barriers that increase the time and complexity of eliciting BPMH, frequent provider turnover at our training institution and lack of an electronic health record (EHR) medication reconciliation tool to facilitate BPMH collection and monitoring.

Design

Leveraging opportunities afforded by the US federal incentive EHR programme, our multidisciplinary team designed an EHR-facilitated medication reconciliation programme by which pharmacy technicians engaged newly admitted patients and their caregivers at the bedside to develop and electronically document the BPMH.

Strategy

Prior to this intervention, pharmacy technicians had no role in BPMH. Providers collected home medications documented on paper notes without a consistent methodology. With each plan–do–study–act (PDSA) cycle since the programme began, the goal was to increase the per cent of BPMH completed by a pharmacy technician. Individual PDSA cycles targeted either the pharmacy technicians by expanding their pool of eligible patients or provider engagement with the pharmacy technician workflow.

Results

By optimising not only the health information technology platform but also the operational processes, the programme achieved a nearly 80% generation of BPMH completed by a highly trained pharmacy technician, surpassing its intended goal of 50% BPMH completion by a pharmacy technician on admission.

Conclusion

An EHR-facilitated tool improved BPMH at an urban academic safety net hospital using pharmacy technicians.
Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices
Authors: Edison Priyantha , Chang Pi Sun , Toh Guan Hong , Lee Li Na , Sanamandra Sarat Kumar , Shah Varsha Atul
Published: October 2017

Aim

Guided by the ALARA - "As Low As Reasonably Achievable" principle in radiation safety, a quality improvement project to optimise the bedside diagnostic imaging process to the best standards of care was conducted over a six month period. The goal was too reduce the radiation hazard opportunities in the neonatal intensive care unit by at least 75% from the existing level at Q2/2015, within 6 months.

Methods

The existing bedside imaging process was critically analysed and the following quality improvement initiatives were implemented namely , mandatory lead protective gear to healthcare staff, gonadal shield for neonates, guidelines for optimal collimation of X-ray beam and optimal positioning of neonates. Radiation dosimetry results, regular staff awareness sessions and strong collaboration between neonatologists, radiologists, radiographers and neonatal nurses helped to ensure compliance to the revised imaging process. Radiation hazard opportunities were measured by analysing all radiographs done during the period under baby exposure and healthcare staff exposure categories.

Summary of results

Radiation hazard opportunities were reduced by 100% to healthcare staff and 75% to neonates, and the overall reduction was 83%. The rate of discordance between radiograph request forms and images taken was measured as a surrogate marker for compliance to the project initiatives and it declined by 77%. Mandatory orientation of staff to the revised policy on the standardised diagnostic imaging process, regular radiation awareness talks and staff feedback sessions are among several measures taken to sustain the project.
Using ‘Active Signposting’ to streamline general practitioner workload in two London-based practices
Authors: Siddiqui Faisal , Sidhu Baljinder , Tahir Mohammad Aumran
Published: October 2017

General practice is at the forefront of the National Health Service, but is currently being overwhelmed by ever-increasing patient demand and financial constraints. Telephone consultations (TCs) have been used as a method to ease pressure on general practice. Many of these consultations are booked with general practioners (GPs), despite occasions when the patient could have either been signposted to self-help or offered an alternative service. This quality improvement project (QIP) aimed to evaluate the nature of TCs undertaken by GPs at our two practices; and whether the patients’ needs could have adequately been met without the involvement of a GP. Consultations where this was the case were deemed ‘possibly avoidable’, and those where involvement with a GP was the best option have been termed ‘essential’. A retrospective analysis was undertaken to establish a baseline figure for the proportion of possibly avoidable TCs in two practices. A new intervention was then introduced, with reception staff following a set of protocols when booking in patients. Patients who did not require a GP to deal with their query were actively signposted by reception staff to other allied healthcare professionals, non-medical staff or an alternative service at the time of booking their appointment. Two practices were involved in the study. After 2 Plan, Do, Study, Act (PDSA) cycles, the proportion of essential consultations taking place at both practices increased from 28.6% and 27.3% at baseline, to 82.6% and 71.4%, respectively. A lower number of possibly avoidable TCs equates to more time for essential TCs and greater value for money for the practice. Patient access to care is also improved, with patients directed to alternative and often quicker services which still meet their needs adequately. With the current system of primary care unable to cope with the demands it faces, interventions such as active signposting provide value for both GP practices and patients alike.