bluuebunny/crossref_metadata_2025 huggingface dataset:
Techno-Economic Optimization of Electricity and Heat Production in a Gas-Fired Combined Heat and Power Plant With a Heat Accumulator
Authors: Żymełka Piotr , Szega Marcin , Madejski Paweł
Published: September 2019

At present, power systems based on gas turbines are mainly used for electricity and heat generation. Gas turbines are used in industrial and institutional applications due to high-temperature exhaust, which can be used for heating, drying, or process steam production. The combined cycle gas turbine plants are a mature technology with high reliability and offering rapid response to changing demand for electricity and heat. The combination of a gas turbine with a heat recovery system and a heat accumulator makes the combined heat and power (CHP) plant a flexible unit. The paper presents the optimization tool for the planning process of electricity and heat production in the gas-fired CHP plant with a heat accumulator. The detailed mathematical model of the analyzed cogeneration plant was developed with the EBSILON®Professional and verified based on the results from on-site tests and warranty measurements. The implemented optimization algorithm is used to maximize the profits of the CHP plant operation. The presented solution is based on an evolutionary algorithm. The optimization algorithm is applied to the production determination for the day-ahead planning horizon, with 1-h time step. The obtained results show that the developed optimization model is a reliable and efficient tool for production planning in a CHP plant with gas turbines. The comparative exergy analysis for different technologies of heat recovery from gas turbine exhaust gases was performed to evaluate the quality of the energy conversion process in the CHP plant.
Cardiac sarcoidosis in a patient with testicular seminoma
Authors: Bhatti Prashan , Waight Michael , Bromage Daniel , Sado Daniel
Published: September 2019

Sarcoidosis is a multisystem disorder characterised by non-caseating granulomas that typically affect the lungs, skin and lymph nodes. Sarcoidosis has been associated with various cancers, and we describe the case of a patient with systemic sarcoidosis associated with testicular seminoma. This was originally diagnosed as stable sarcoid-like reaction. He subsequently presented with ventricular tachycardia. Cardiovascular MRI suggested cardiac sarcoidosis, which was confirmed by myocardial biopsy. This case highlights the association between some types of cancer and sarcoidosis. In addition, it highlights the importance of close follow-up for patients with a history of malignancy to monitor for sarcoid-like reactions and sarcoidosis, which are often difficult to differentiate clinically.
Dural carotid cavernous fistula following hypertensive emergency
Authors: Law Geoffrey , Docherty Gavin
Published: September 2019

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.
Failed knee replacement: incorrect indication?
Authors: Ampat George , Tixerant Emma
Published: September 2019

A 52-year-old woman sustained a direct soft tissue injury to the right knee following a fall onto the right knee. X-rays did not identify any bony injury. Physiotherapy decreased pain but instability persisted. MRI scans identified early degeneration. An orthopaedic opinion recommended total knee replacement. Following a total knee replacement, the pain has worsened and she remains functionally impaired 2 years following the surgical intervention. Knee replacements are commonly performed successful surgical interventions. The increased numbers of replacements might be due to the lowered threshold in recommending surgical intervention by health professionals. This may increase the failure rate. It also raises the question whether adequate non-operative measures were attempted?
Catastrophic antiphospholipid syndrome in pregnancy: a life-threatening condition
Authors: Collict Mandy , Sciberras Buhagiar Whitney , Mercieca Cecilia , Thake John
Published: September 2019

Catastrophic antiphospholipid syndrome (CAPS) is a rare and potentially life-threatening variant of the antiphospholipid syndrome which is characterised by multiple small vessel thrombosis which can lead to multiorgan failure. CAPS is a clinical emergency which all clinicians need to be aware of because early diagnosis and treatment may improve maternal and fetal outcome. Here, we report a case of CAPS in pregnancy in a 31-year-old female patient who presented at 28 weeks of gestation. A literature review of CAPS in pregnancy and the puerperium is also included.
Leptomeningeal involvement by prostate carcinoma an ominous head of a well-known Hydra
Authors: Tawadros Fady , Manthri Sukesh , Zayko Maria , Chakraborty Kanishka
Published: September 2019

A 67-year-old male patient presents to the hospital complaining of severe nausea and vomiting failing oral antiemetics. He carries the history of initial diagnosis of stage III prostate cancer. He underwent radical prostatectomy followed by external beam radiation. After 5 years of initial excellent control with androgen deprivation therapy (ADT), imaging study showed retroperitoneal adenopathy denoting ADT failure. His prostate-specific antigen continued to rise while on enzalutamide and then abiraterone reflecting disease progression. He maintained excellent functional capacity through 23 cycles of docetaxel however he started developing hip pain after the last cycle with imaging studies suggesting new hip metastatic disease. Following the first cycle of radium-223, the patient presented with intractable nausea and vomiting. MRI showed a high suspicion of leptomeningeal spread which was confirmed through a meningeal biopsy after lumbar puncture showed negative results. The patient had excellent symptomatic response to high-dose dexamethasone. After receiving whole-brain radiation, the patient opted to be on best supportive care and succumbed to his illness 3 months later.
Specificity of various cluster criteria used for the detection of glaucomatous visual field abnormalities
Authors: Wu Zhichao , Medeiros Felipe A , Weinreb Robert N , Girkin Christopher A , Zangwill Linda M
Published: September 2019

Purpose

This study aimed to evaluate the specificity of commonly used cluster criteria for defining the presence of glaucomatous visual field abnormalities and the impact of variations in the criterion used.

Methods

This is an observational study including 607 eyes from 384 healthy participants, and 501 eyes of 345 participants with glaucoma, with at least two reliable 24–2 visual field tests. An abnormal visual field cluster was defined as the presence of ≥3 contiguous abnormal locations. Variations in this definition were evaluated and included (1) whether abnormalities were based on total deviation and/or pattern deviation values; (2) probability cut-off for defining an abnormal location; and (3) whether abnormalities were required to be repeatable (within the same hemifield or at the same locations) or not. These definitions were also compared against pattern standard deviation (PSD) values.

Results

False-positive rates of various cluster criteria ranged between 9% and 46% depending on the specific definitions used. Only definitions that required abnormalities to be repeatable at the same location achieved a false-positive rate of ≤6%. The various cluster criteria generally performed similarly or worse at detecting glaucoma eyes compared with the PSD values.

Conclusions

Commonly used visual field cluster criteria have high false-positive rates that vary widely depending on the definition used. These findings highlight the need to carefully consider the criteria used when designing and interpreting glaucoma clinical studies.

Trial registration number

NCT00221923.
Prediction system for risk of allograft loss in patients receiving kidney transplants: international derivation and validation study
Authors: Loupy Alexandre , Aubert Olivier , Orandi Babak J , Naesens Maarten , Bouatou Yassine , Raynaud Marc , Divard Gillian , Jackson Annette M , Viglietti Denis , Giral Magali , Kamar Nassim , Thaunat Olivier , Morelon Emmanuel , Delahousse Michel , Kuypers Dirk , Hertig Alexandre , Rondeau Eric , Bailly Elodie , Eskandary Farsad , Böhmig Georg , Gupta Gaurav , Glotz Denis , Legendre Christophe , Montgomery Robert A , Stegall Mark D , Empana Jean-Philippe , Jouven Xavier , Segev Dorry L , Lefaucheur Carmen
Published: September 2019

Objective

To develop and validate an integrative system to predict long term kidney allograft failure.

Design

International cohort study.

Setting

Three cohorts including kidney transplant recipients from 10 academic medical centres from Europe and the United States.

Participants

Derivation cohort: 4000 consecutive kidney recipients prospectively recruited in four French centres between 2005 and 2014. Validation cohorts: 2129 kidney recipients from three centres in Europe and 1428 from three centres in North America, recruited between 2002 and 2014. Additional validation in three randomised controlled trials (NCT01079143, EudraCT 2007-003213-13, and NCT01873157).

Main outcome measure

Allograft failure (return to dialysis or pre-emptive retransplantation). 32 candidate prognostic factors for kidney allograft survival were assessed.

Results

Among the 7557 kidney transplant recipients included, 1067 (14.1%) allografts failed after a median post-transplant follow-up time of 7.12 (interquartile range 3.51-8.77) years. In the derivation cohort, eight functional, histological, and immunological prognostic factors were independently associated with allograft failure and were then combined into a risk prediction score (iBox). This score showed accurate calibration and discrimination (C index 0.81, 95% confidence interval 0.79 to 0.83). The performance of the iBox was also confirmed in the validation cohorts from Europe (C index 0.81, 0.78 to 0.84) and the US (0.80, 0.76 to 0.84). The iBox system showed accuracy when assessed at different times of evaluation post-transplant, was validated in different clinical scenarios including type of immunosuppressive regimen used and response to rejection therapy, and outperformed previous risk prediction scores as well as a risk score based solely on functional parameters including estimated glomerular filtration rate and proteinuria. Finally, the accuracy of the iBox risk score in predicting long term allograft loss was confirmed in the three randomised controlled trials.

Conclusion

An integrative, accurate, and readily implementable risk prediction score for kidney allograft failure has been developed, which shows generalisability across centres worldwide and common clinical scenarios. The iBox risk prediction score may help to guide monitoring of patients and further improve the design and development of a valid and early surrogate endpoint for clinical trials.

Trial registration

Clinicaltrials.gov NCT03474003.
Effectiveness of a multifactorial context-enhancing functional therapy to promote functional arm use and recovery of stroke survivors: study protocol for a clinical trial
Authors: Rajagopalan Vasanthan , Natarajan Manikandan , Gorthi Sankar Prasad , Padickaparambil Sebastian , Solomon John M
Published: September 2019

Introduction

After a stroke, 55% of survivors do not regain the ability to completely use their arm in daily life functioning. Currently, evidence-based guidelines recommend functional training for improving the affected hand after stroke. However, promoting an optimal quantity and quality of functional training is influenced by personal and environmental contextual factors. Studies that comprehensively target multiple factors regulating arm use are limited. This study compares the effects of functional training to multifactorial context-enhancing functional training program for improving functional arm use and recovery after stroke.

Methods and analysis

This is a protocol for an observer-blinded, two parallel groups, randomised controlled trial. A total of 126 community-dwelling subacute and chronic stroke survivors will be included in the study. A tailor-made multifactorial context-enhancing intervention-incorporating education, environmental enrichment and behaviour change techniques to reinforce functional training will be provided to the experimental group. The functional training group will be provided with functional exercises. The intervention will be delivered for 2 months. The primary outcomes of functional arm use and recovery will be measured using Motor Activity Log, Goal Attainment Scale and Rating of Everyday Arm-use in the Community and Home scale. The secondary outcomes of arm motor impairment and function will be measured using Fugl-Meyer upper limb score, Action Research Arm Test, ABILHAND questionnaire and Stroke Impact Scale. These will be measured at three points in time: before, after 2 months and after 1-month follow-up. The outcome measures will be analysed using one-way analysis of variance and regression analysis will be performed to identify factors limiting optimal task practice.

Ethics and dissemination

The study has been approved by the Institutional Ethics Committee of Kasturba Hospital, Manipal, India. Participants will sign a written informed consent prior to participation. The results will be published on completion of the trial and communicated to community-dwelling stroke survivors.

Trial registration number

CTRI/2017/10/010108
Suicidal behaviour in postnatal mothers in northwestern Ethiopia: a cross-sectional study
Authors: Belete Habte , Misgan Eyaya
Published: September 2019

Aim

To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers.

Method

An institutional cross-sectional study was employed from March to April 2017.

Setting

Two primary health centres and one referral hospital in northwestern Ethiopia.

Participants

A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included.

Outcome measure

Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance.

Results

The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours.

Conclusion

Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care.
Vulnerability to fatal drowning among the population in Southern Bangladesh: findings from a cross-sectional household survey
Authors: Rahman Aminur , Jagnoor Jagnoor , Baset Kamran ul , Ryan Dan , Ahmed Tahera , Rogers Kris , Hossain Mohammad Jahangir , Ivers Rebecca , Rahman A K M Fazlur
Published: September 2019

Objectives

This study aimed to determine the fatal drowning burden and associated risk factors in Southern Bangladesh.

Settings

The survey was conducted in 39 subdistricts of all 6 districts of the Barisal division, Southern Bangladesh.

Participants

All residents (for a minimum 6 months prior to survey) of the Barisal division, Southern Bangladesh.

Intervention/methods

A cross-sectional, divisionally representative household survey was conducted in all six districts of the Barisal division between September 2016 and February 2017, covering a population of 386 016. Data were collected by face-to-face interview with adult respondents using handheld electronic tablets. International Classification of Diseases (ICD)-v. 10 (ICD-10) Chapter XX: External causes of morbidity and mortality codes for drowning, W65–W74, X36–X39, V90, V92, X71 or X92, were used as the operational definition of a drowning event.

Results

The overall fatal drowning rate in Barisal was 37.9/100 000 population per year (95% CI 31.8 to 43.9). The highest fatal drowning rate was observed among children aged 1–4 years (262.2/100 000/year). Mortality rates among males (48.2/100 000/year) exceeded that for females (27.9/100 000/year). A higher rate of fatal drowning was found in rural (38.9/100 000/year) compared with urban areas (29.3/100 000/year). The results of the multivariable logistic regression identified that the factors significantly associated with fatal drowning were being male (OR 1.7, 95% CI 1.2 to 2.3), aged 1–4 years (OR 3.0, 95% CI 1.4 to 6.4) and residing in a household with four or more children (four or more children OR 1.8, 95% CI 1.1 to 2.9; and five or more children OR 2.1, 95% CI 1.2 to 3.7).

Conclusion

Drowning is a public health problem, especially for children, in the Barisal division of Southern Bangladesh. Male gender, children 1–4 years of age and residing in a household with four or more children were associated with increased risk of fatal drowning events. The Barisal division demands urgent interventions targeted at high-risk groups identified in the survey.
Use of antimicrobial dressings in England and the association with published clinical guidance: interrupted time series analysis
Authors: Hussey Louise , Stocks Susan J , Wilson Paul , Dumville Jo C , Cullum Nicky
Published: September 2019

Objectives

In healthcare systems, practices and products of unproven value and cost-effectiveness can decrease value and increase waste. Using the management of complex wounds, this study investigates temporal trends in the use of antimicrobials dressings, places this in the context of available evidence and discusses the potential impacts on the UK National Health Service (NHS).

Design

Secondary descriptive and interrupted time series (ITS) analysis of NHS prescription data.

Setting

Prescribing Cost Analysis (PCA) details all NHS prescriptions dispensed in the community in England.

Interventions

An ITS design was used to compare annual changes in the expenditure and use of antimicrobial and non-antimicrobial dressings before and after the publication of the ‘intervention’ of key evidence-based Scottish Intercollegiate Guidelines Network (SIGN) guidance in 2010.

Primary and secondary outcome measures

Trends in use and expenditure of antimicrobial dressings in relation to published clinical guidance.

Results

There was a large increase in the prescribing of, and expenditure on, antimicrobial wound dressings between 1997 and 2016. In 1997, the total number of dressings prescribed was 5 792 700; increasing to 11 447 102 in 2009 with expenditure increasing from £1 960 386 to £32 841 263. During the year of the SIGN intervention (2010), there was a significant drop in the use of silver but there was no consistent ongoing reduction from 2011 to 2015.

Conclusions

Prescribing data can be used to identify products of unproven benefit, which also impose a significant financial burden. This study quantifies the huge increase in the use of antimicrobial wound dressings over a 20-year period despite the lack of compelling evidence to support their routine use. There is some suggestion, however that the use and expenditure decreased after the publication of key guidance. Routine data can be used to as part of more systematic efforts to increase value and reduce waste in health systems.
Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey
Authors: Ali Nausad , Akram Raisul , Sheikh Nurnabi , Sarker Abdur Razzaque , Sultana Marufa
Published: September 2019

Objectives

To determine the sex-specific prevalence, inequality and factors associated with healthcare utilisation for diabetes mellitus (DM), hypertension and comorbidity among the adult population of Bangladesh.

Study design

This study analysed cross-sectional nationwide Bangladesh Demographic and Health Survey data from 2011. Comorbidity was defined as the coexistence of both DM and hypertension. Several socioeconomic and demographic factors such as age, sex, education, geographic location, administrative division, employment status, education and wealth index were considered as major explanatory variables. Inequality in prevalence and healthcare utilisation was measured using the ‘Lorenz curve’. Adjusted multiple logistic regression models were performed to observe the effects of different factors and reported as adjusted ORs (AORs) with 95% CIs. A p value of <0.05 was adopted as the level of statistical significance.

Setting

The study was conducted in Bangladesh.

Participants

A total of 7521 adult participants with availability of biomarkers information were included.

Results

The mean age of the study participants was 51.4 years (SD ±13.0). The prevalence of hypertension, diabetes and comorbidity were 29.7%, 11.0% and 4.5% respectively. Socioeconomic inequality was observed in the utilisation of healthcare services. A higher prevalence of hypertension and comorbidity was significantly associated with individuals aged >70 years (AOR 7.0, 95% CI 5.0 to 9.9; AOR 6.7, 95% CI 3.0 to 14.9). The risk of having hypertension, diabetes and comorbidity were significantly higher among more educated, unemployed as well as among individuals from Khulna division.

Conclusions

The study revealed a rising prevalence of hypertension, diabetes and comorbidity with inequality in service utilisation. A joint effort involving public, private and non-governmental organisations is necessary to ensure improved accessibility in service utilisation and to reduce the disease burden.
Ambulatory cancer care electronic symptom self-reporting (ACCESS) for surgical patients: a randomised controlled trial protocol
Authors: Stabile Cara , Temple Larissa K , Ancker Jessica S , Basch Ethan , Carter Jeanne , Miranda Magen , Stein Daniel , Stetson Peter D , Vickers Andrew , Simon Brett A , Pusic Andrea L
Published: September 2019

Introduction

An increasing proportion of cancer surgeries are ambulatory procedures requiring a stay of 1 day or less in the hospital. Providing patients and their caregivers with ongoing, real-time support after discharge aids delivery of high-quality postoperative care in this new healthcare environment. Despite abundant evidence that patient self-reporting of symptoms improves quality of care, the most effective way to monitor and manage this self-reported information is not known.

Methods and analysis

This is a two-armed randomised, controlled trial evaluating two approaches to the management of patient-reported data: (1) team monitoring, symptom monitoring by the clinical team, with nursing outreach if symptoms exceed normal limits, and (2) enhanced feedback, real-time feedback to patients about expected symptom severity, with patient-activated care as needed.

Patients with breast, gynaecologic, urologic, and head and neck cancer undergoing ambulatory cancer surgery (n=2750) complete an electronic survey for up to 30 days after surgery that includes items from a validated instrument developed by the National Cancer Institute, the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Information provided to patients in the Enhanced Feedback group is procedure-specific and based on updated PRO-CTCAE data from previous patients. Qualitative interviews are also performed. The primary study outcomes assess unplanned emergency department visits and symptom-triggered interventions (eg, nursing calls and pain management referrals) within 30 days, and secondary outcomes assess the patient and caregiver experience (ie, patient engagement, patient anxiety and caregiver burden).

Ethics and dissemination

This study is approved by the Institutional Review Board at Memorial Sloan Kettering Cancer Center. The relationships between the study team and stakeholders will be leveraged to disseminate study findings. Findings will be relevant in designing future coordinated care models targeting improved healthcare quality and patient experience.

Trial registration number

NCT03178045
Psychosocial work demands and physical workload decrease with ageing in blue-collar and white-collar workers: a prospective study based on the SLOSH cohort
Authors: Åkerstedt Torbjörn , Discacciati Andrea , Häbel Henrike , Westerlund Hugo
Published: September 2019

Objectives

Psychosocial work demands and physical workload are important causes of ill health. The dramatic demographic changes in society make it important to understand if such factors change with ageing, but this is presently not known. The purpose of the present study was to investigate whether psychosocial work demands and physical workload change across 8 years of ageing, whether occupational groups show different trajectories of change and if such trajectories are reflected in sleep or fatigue.

Methods

A cohort of 5377 participants (mean age: 47.6±11.6 (SD) years, 43.2% males, 40.2% blue-collar workers) was measured through self-report in five biannual waves across 8 years. Mixed model regression analyses was used to investigate change across ageing.

Results

Psychosocial work demands decreased significantly across 8 years (Coeff: −0.016±0.001), with the strongest decrease in the high white-collar group (Coeff=−0.031±0.003) and the oldest group. Physical workload also decreased significantly (Coeff=−0.032±0.002), particularly in the blue-collar group (Coeff=−0.050±0.004) and in the oldest group. Fatigue decreased, and sleep problems increased with ageing, but with similar slopes in the occupational groups. All effect sizes were small, but extrapolation suggests substantial decreases across a working life career.

Conclusions

The decrease in psychosocial work demands and physical workload suggests that the burden of work becomes somewhat lighter over 8 years. The mechanism could be ‘pure’ ageing and/or increased experience or related factors. The gradual improvement in the work situation should be considered in the discussion of the place of older individuals in the labour market, and of a suitable age for retirement. The results also mean that prospective studies of work and health need to consider the improvement in working life with ageing.
Educating hospital patients to prevent falls: protocol for a scoping review
Authors: Heng Hazel , Jazayeri Dana , Shaw Louise , Kiegaldie Debra , Hill Anne-Marie , Morris Meg E
Published: September 2019

Introduction

Falls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended.

Methods and analysis

The analysis will apply the methodological framework developed by Arksey and O’Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed search strategy of Medical Subject Headings and text words will be conducted of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, PsychINFO, Education Resources Information Center and grey literature databases from January 2008 to current. The reference lists of included articles will be hand searched for additional studies. Two reviewers will screen the titles and abstracts independently and analyse the full text of potential articles based on the inclusion and exclusion criteria. The data will be extracted using a structured data form. Thematic analysis and numerical synthesis of the data will be conducted, and key themes will be identified.

Ethics and dissemination

Results of this scoping review will illuminate the designs and outcomes of patient education research for hospital falls prevention in the current literature. It is anticipated that the findings will highlight best-practice educational design to inform the development of future patient-focused education for falls prevention. Study findings will be presented at relevant conferences and public forums, and published in peer-reviewed journals. Ethics approval is not required.
Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt—an interim analysis
Authors: Labib Mohamed E , Hassanein Olfat E , Moussa Makeen , Yassen Asmaa , Schwendicke Falk
Published: September 2019

Objectives

To compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions.

Design

Randomised controlled, unicentre, clustered two-arm superiority trial.

Setting

Outpatient clinic of a private university in Cairo, Egypt.

Participants

One hundred and fifteen participants (n=132 teeth), aged 18–47 years, from Cairo, Egypt, were enrolled. Premolars/molars with occlusal/occlusal-proximal deep lesions (radiographically >2/3 dentine), sensible pulps, without spontaneous pain, were included.

Interventions

Peripheral carious tissue removal to hard dentine was performed. Pulpo-proximally, soft dentine was left. A glass ionomer (GI) restoration was placed. After 3–4 months, teeth were randomly allocated to SE (n=66), with reduction of the GI into a base and no further tissue removal, followed by a composite resin restoration, or SW (n=66), with full removal of the GI, additional excavation until firm dentine pulpo-proximally, followed by a GI-based composite restoration. Mean follow-up was 1 year.

Primary and secondary outcome measures

Primary outcome was success (absence of endodontic/restorative complications). Secondary outcomes were tooth survival and initial and total treatment costs.

Results

Zero/five pulp exposures occurred during SE/SW, and seven/five SE/SW teeth required endodontic therapy. Success after 12 months was 89.4% for SE and 84.9% for SW. The estimated mean time free of complications was 23 and 18 months for SE and SW, respectively, without significant differences between SE and SW (p>0.05/Cox). Initial treatment costs were significantly higher for SW (mean (SD): 507.5 (123.4) Egyptian pounds (EGP)) than SE (mean (SD): 456.6 (98.3) EGP), while total costs showed no significant difference (p>0.05).

Conclusion

Within the limitations of this interim analysis, and considering the depth of these lesions (>2/3 dentine), SE and SW showed similar risk of failure and overall costs after 1 year.

Trial registration number

PACTR201603001396248.
Socioeconomic and lifestyle factors associated with hearing loss in older adults: a cross-sectional study of the English Longitudinal Study of Ageing (ELSA)
Authors: Tsimpida Dialechti , Kontopantelis Evangelos , Ashcroft Darren , Panagioti Maria
Published: September 2019

Objectives

Aims were (1) to examine whether socioeconomic position (SEP) is associated with hearing loss (HL) among older adults in England and (2) whether major modifiable lifestyle factors (high body mass index, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) are associated with HL after controlling for non-modifiable demographic factors and SEP.

Setting

We used data from the wave 7 of the English Longitudinal Study of Ageing, which is a longitudinal household survey dataset of a representative sample of people aged 50 and older.

Participants

The final analytical sample was 8529 participants aged 50–89 that gave consent to have their hearing acuity objectively measured by a screening audiometry device and did not have any ear infection.

Primary and secondary outcome measures

HL defined as >35 dBHL at 3.0 kHz (better-hearing ear). Those with HL were further subdivided into two categories depending on the number of tones heard at 3.0 kHz.

Results

HL was identified in 32.1% of men and 22.3% of women aged 50–89. Those in a lower SEP were up to two times more likely to have HL; the adjusted odds of HL were higher for those with no qualifications versus those with a degree/higher education (men: OR 1.87, 95%CI 1.47 to 2.38, women: OR 1.53, 95%CI 1.21 to 1.95), those in routine/manual occupations versus those in managerial/professional occupations (men: OR 1.92, 95%CI 1.43 to 2.63, women: OR 1.25, 95%CI 1.03 to 1.54), and those in the lowest versus the highest income and wealth quintiles (men: OR 1.62, 95%CI 1.08 to 2.44, women: OR 1.36, 95%CI 0.85 to 2.16, and men: OR1.72, 95%CI 1.26 to 2.35, women: OR 1.88, 95%CI 1.37 to 2.58, respectively). All regression models showed that socioeconomic and the modifiable lifestyle factors were strongly associated with HL after controlling for age and gender.

Conclusions

Socioeconomic and lifestyle factors are associated with HL among older adults as strongly as core demographic risk factors, such as age and gender. Socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.
Passive versus active intra-abdominal drainage following pancreatic resection: does a superior drainage system exist? A protocol for systematic review
Authors: Park Lily , Baker Laura , Smith Heather , Davies Alexandra , Abou Khalil Jad , Martel Guillaume , Balaa Fady , Bertens Kimberly A
Published: September 2019

Background

Clinically relevant postoperative pancreatic fistula (CR-POPF) is the most common cause of major morbidity following pancreatic resection. Intra-abdominal drains are frequently positioned adjacent to the pancreatic anastomosis or transection margin at the time of surgery to aid in detection and management of CR-POPF. Drains can either evacuate fluid by passive gravity (PG) or be attached to a closed suction (CS) system using negative pressure. There is controversy as to whether one of these two systems is superior. The objective of this review is to identify and compare the incidence of adverse events (AEs) and resource utilisation associated with PG and CS drainage following pancreatic resections.

Methods and analysis

MEDLINE, EMBASE, CINAHL and Cochrane Central Registry of Controlled Trials will be searched from inception to April 2019, to identify interventional and observational studies comparing PG and CS drains following pancreatic resection. The primary outcome is POPF as defined by the International Study Group for Pancreatic Fistula in 2017. Secondary outcomes include postoperative AE, resource utilisation (length of stay, return to emergency department, readmission and reintervention), time to drain removal and quality of life. Study selection, data extraction and risk of bias assessment will be performed independently, by two reviewers. A meta-analysis will be conducted if deemed statistically appropriate. Subgroup analysis by study design will be performed. Study heterogeneity will be calculated with the χ2test and reported as I2statistics. Statistical analyses will be conducted and displayed using RevMan V.5.3

Ethics and dissemination

Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and peer-reviewed journals for publication.

PROSPERO registration number

CRD42019123647.
Supporting the provision of pharmacy medication reviews to marginalised (medically underserved) groups: a before/after questionnaire study investigating the impact of a patient–professional co-produced digital educational intervention
Authors: Latif Asam , Waring Justin , Chen Li-chia , Pollock Kristian , Solomon Josie , Gulzar Nargis , Gulzar Sulma , Anderson Emma , Choudhary Shahida , Abbasi Nasa , Wharrad Heather J , Anderson Claire
Published: September 2019

Objectives

People who are marginalised (medically underserved) experience significant health disparities and their voices are often ‘seldom heard’. Interventions to improve professional awareness and engagement with these groups are urgently needed. This study uses a co-production approach to develop an online digital educational intervention in order to improve pharmacy staffs’ intention to offer a community pharmacy medication review service to medically underserved groups.

Design

Before/after (3 months) self-completion online questionnaire.

Setting

Community pharmacies in the Nottinghamshire (England) geographical area.

Participants

Community pharmacy staff.

Intervention

Online digital educational intervention.

Primary and secondary outcome measures

The primary outcome measure was ‘behaviour change intention’ using a validated 12-item survey measure. The secondary outcome measure was pharmacist self-reported recruitment of underserved groups to the medication review service.

Results

All pharmacies in the Nottinghamshire area (n=237) were approached in June 2017 and responses were received from 149 staff (from 122 pharmacies). At 3 months (after completing the baseline questionnaire), 96 participants (from 80 pharmacies) completed a follow-up questionnaire, of which two-thirds (n=62) reported completing the e-learning. A before/after comparison analysis found an improving trend in all the five constructs of behaviour change intention (intention, social influence, beliefs about capabilities, moral norms and beliefs about consequences), with a significant increase in mean score of participants’ ‘beliefs about capabilities’ (0.44; 95% CI 0.11 to 0.76, p=0.009). In the short-term, no significant change was detected in the number of patients being offered and the patient completing a medication review.

Conclusions

Although increases in the numbers of patients being offered a medication review was not detected, the intervention has the potential to significantly improve pharmacy professionals’ 'beliefs about capabilities' in the short-term. Wider organisational and policy barriers to engagement with marginasied groups may need to be addressed. Future research should focus on the interplay between digital learning and practice to better identify and understand effective practice change pathways.
Facilitators, barriers and ethical values related to the coordination of return-to-work among employees on sick leave due to common mental disorders: a protocol for a qualitative study (the CORE-project)
Authors: Björk Brämberg Elisabeth , Sandman Lars , Hellman Therese , Kwak Lydia
Published: September 2019

Introduction

Diagnoses related to common mental disorders such as anxiety, depression, adjustment disorders and stress-related disorders are one of the leading causes of long-term sick leave for both women and men in Organisation for Economic Co-operation and Development countries. To increase the rate of return-to-work workplace involvement in a coordinated return-to-work process has been included in recent best practice guidelines. This form of cooperation is a complex process, involving political structures and a wide range of stakeholders. The study’s first aim is to describe facilitators and barriers to the coordination of return-to-work from the perspectives of: (A) employees on sick leave due to common mental disorders, (B) employers, (C) rehabilitation coordinators, (D) physicians and (E) other stakeholders. The second aim is to identify ethical issues that arise in the coordination of return-to-work and analyse how these can be resolved.

Methods and analysis

The study has a qualitative design using interviews with employees on sick leave due to common mental disorders, employers, rehabilitation coordinators, physicians and other stakeholders. The study is conducted in the Swedish primary healthcare. Employees, employers and rehabilitation coordinators are recruited via primary healthcare centres. Rehabilitation coordinators receive information about the study and those who consent to participation are asked to recruit employees and employers. Interview guides have been developed from the consolidated framework for implementation research and ethical values and norms found in Swedish healthcare, social services and workplace legislation. Data will be analysed with qualitative content analysis reflecting manifest and latent content, and ethical issues will be analysed by means of reflective equilibrium methodology.

Ethics and dissemination

The study was approved by the Regional Ethical Review Board in Stockholm, Sweden (Reg.no 2018/677-31/2 and 2018/2119–32). The findings will be disseminated through publication in scientific journals, social media, seminars and national and international conferences.
Nursing home hospital transfers in the terminally ill: night shift nurses matter!
Authors: Economos Guillaume , Tholly Francoise , Rhondali Wadih , Ruer Murielle , Tricou Colombe , Fawoubo Audrey , Perceau-Chambard Élise , Filbet Marilene
Published: September 2019

Background

French demographic projection expects an increasing number of older, dependent patients in the next few years. A large proportion of this population lives in nursing homes and their transfer to hospitals at the end of life is an ongoing issue.

Objective

This study explored the factors influencing the transfer of patients living in nursing homes to hospital at the end of life.

Design

We used a mixed-methods questionnaire developed by an expert group and assessing different characteristics of the nursing homes.

Participants

All the nursing homes in the Rhône-Alpes area (n=680) were surveyed.

Results

We obtained 466 (68%) answers. We found that a palliative care programme was present in 336 (72%) nursing homes. The majority had a coordinating physician 428 (82%) and a mean number of 6 nurses for 83 beds, with 83 (18%) having a night shift nurse. There was a mean number of 19 deaths per nursing home during the recorded year. The main cause of death was dementia (41%), cancer-related death (13%). Death occurred mostly in the nursing home (14 74%). Night shift nurse attendance was significantly associated with the place of death: 27 deaths occurred in nursing homes with a night shift nurse versus 12 in those without one (p<0001).

Conclusions

The location of the death of frail elderly patients is a major health issue that needs to be addressed. Our results suggests that the presence of a night shift nurse decreases the number of emergency transfers and deaths in the hospital.
Rilpivirine attenuates liver fibrosis through selective STAT1-mediated apoptosis in hepatic stellate cells
Authors: Martí-Rodrigo Alberto , Alegre Fernando , Moragrega Ángela B , García-García Francisco , Martí-Rodrigo Pablo , Fernández-Iglesias Anabel , Gracia-Sancho Jordi , Apostolova Nadezda , Esplugues Juan V , Blas-García Ana
Published: September 2019

Objective

Liver fibrosis constitutes a major health problem worldwide due to its rapidly increasing prevalence and the lack of specific and effective treatments. Growing evidence suggests that signalling through cytokine-activated Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathways regulates liver fibrosis and regeneration. Rilpivirine (RPV) is a widely used anti-HIV drug not reported to produce hepatotoxicity. We aimed to describe the potential hepatoprotective effects of RPV in different models of chronic liver injury, focusing on JAK-STAT signalling regulation.

Design

The effects of RPV on hepatic steatosis, inflammation and fibrogenesis were studied in a nutritional mouse model of non-alcoholic fatty liver disease, carbon tetrachloride-induced fibrosis and bile duct ligation-induced fibrosis. Primary human hepatic stellate cells (hHSC) and human cell lines LX-2 and Hep3B were used to investigate the underlying molecular mechanisms.

Results

RPV exerted a clear anti-inflammatory and antifibrotic effect in all the in vivo models of liver injury employed, and enhanced STAT3-dependent proliferation in hepatocytes and apoptosis in HSC through selective STAT1 activation. These results were reproduced in vitro; RPV undermined STAT3 activation and triggered STAT1-mediated pathways and apoptosis in HSC. Interestingly, this selective pro-apoptotic effect completely disappeared when STAT1 was silenced. Conditioned medium experiments showed that HSC apoptosis activated STAT3 in hepatocytes in an interleukin-6-dependent mechanism.

Conclusion

RPV ameliorates liver fibrosis through selective STAT1-dependent induction of apoptosis in HSC, which exert paracrinal effects in hepatocytes, thus promoting liver regeneration. RPV’s actions may represent an effective strategy to treat chronic liver diseases of different aetiologies and help identify novel therapeutic targets.
Clinical trials of neurointervention : 2007–2018
Authors: Saber Hamidreza , Jadhav Ashutosh P , Rajah Gary B , Narayanan Sandra , Sheth Sunil A , Liebeskind David S , Somai Melek
Published: September 2019

Background

ClinicalTrials.gov is one of the largest trials’ registries in the world.

Objective

To leverage the ClinicalTrials.gov database to define the portfolio of clinical trials of neurointervention.

Methods

We restricted our extraction to interventional clinical trials submitted between 2007 and 2018, and included MeSH terms that are part of the nervous system (n=19 344) or cardiovascular disease (n=19 234) categories and included a list of neurointerventional terms. The characteristics of trials, geographic distribution, dissemination, and funding sources were explored using descriptive and regression models.

Results

A total of 206 neurointerventional clinical trials across 1691 medical centers were identified. Acute stroke was the most studied conditions (68, 33%), followed by aneurysms (63, 31%), carotid stenosis (48, 24%), intracranial atherosclerotic disease (7, 3.5%), cerebral venous thrombosis (6, 3%), arteriovenous malformation (4, 2%), idiopathic intracranial hypertension (3, 1.5%), and others (6, 3%). Overall, 59 (29%) trials were completed, 79 (37%) were active trials (28% recruiting), and 22 (11%) were terminated or suspended. Academic centers and industry were the most common primary funding source (63% and 29%, respectively), with no funding source reported in 16 (7.7%) trials. Among 77 completed or terminated trials, only 9 (11.7%) trials reported findings within 12 months. Median time to publication for trials funded by academia was 1.66 years (interquartile range (IQR) 0.7–2.1) versus 2.1 years (IQR 1.2–3.25) for industry-funded studies.

Conclusions

A low dissemination rate for results and a high rate of study non-completion, as well as lack of geographic dispersion of trials appear to be major challenges in the field.