bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations of Dermatological Findings in New-Borns of a Community Hospital in Nepal
Authors: Shrestha Asim , Shrestha Smriti
Published: June 2018

Introduction: Skin manifestations are common in neonates. The prevalence of skin changes and their association with neonatal and maternal factors are not adequately documented in Nepal. It is important to differentiate common benign skin lesions from infrequent skin changes that cause morbidity, requiring medical management. The objectives of this study were to determine the pattern of skin lesions in new-borns and their association with maternal and neonatal variables.Material and Methods: This was a prospective, cross-sectional study conducted in obstetric unit of the hospital from December 2016 to May 2017. Outborn babies and babies shifted to NICU were excluded.Results: A total of 935 new-borns were examined. The commonest skin lesions were Mongolian spot (66.7%), Erythema toxicum (46.6%), Milia (44.4%), Epstein pearls (26.4%) and Salmon patch (11.9%). Mothers aged 35 years or older (63.6%) had statistically significant association with Erythema toxicum (p=0.01). Erythema toxicum was more in primiparity, term pregnancy and caesarean section delivery. Milia was associated with male babies. Salmon patch was seen more in term pregnancy. Congenital melanocytic nevus, haemangioma and port-wine stain were noted in three, two and one new-borns respectively, which alter morbidity and hence are important to diagnose in time.Conclusion: We found that 93.8% of neonates had at one or more skin lesions. The majority of skin lesions were benign and transient. Erythema toxicum was seen commonly in mothers aged 35 and more. Salmon patch was seen more in term pregnancy.
Transient Abnormal Myelopoiesis in a Neonate without Down Syndrome
Authors: Shrestha Rupesh
Published: June 2018

Transient abnormal myelopoiesis (TAM) also known as transient myeloproliferative disorder (TMD), a unique transient neonatal preleukaemic disorder characterized by clonal proliferation of megakaryoblasts, has been usually described to be associated with Down syndrome neonates. However, there are case reports of it occurring in neonates without Down phenotype, who are either mosaic for trisomy 21 or have trisomy 21 restricted to leukemic clone. This case report presents a case of TAM in a phenotypically normal neonate who presented in respiratory distress with features of tumour lysis syndrome (TLS) immediately after birth who was treated symptomatically and had spontaneous remission within three months.
FAKTOR YANG MEMPENGARUHI TINGKAT KEPERCAYAAN MASYARAKAT TERHADAP ECOMMERCE
Authors: Sari Putri Pradnyawidya
Published: June 2018

Tingginya pengguna media online di Indonesia menimbulkan optimisme para pelaku industri untuk mulai beralih kebisnis media online. Para creator digital mulai mengkonvergen segala bentuk perkembangan gaya hidup masyarakat dengan teknologi digital termasuk ecommerce.  Banyaknya ecommerce yang bermunculan di internet menyebabkan masyarakat mempunyai banyak pilihan untuk memanfaatkannya. Oleh karena itu ketika media online ecommerce menjadi sangat produktif di internet maka menjadi menarik apabila melakukan analisis mengenai parameter-parameter yang mempengaruhi media online ecommerce dan sejauh mana tingkat kepercayaan masyarakat terhadap website travel. Dengan menggunakan analisis deskriptif dan analisis regresi linier berganda maka diharapkan dapat memberikan analisa yang compatibel mengenai media online ecommerce. Berdasarkan analisa yang sudah dilakukan terhadap data yang diperoleh dari survei online untuk penelitian analisis faktor kepercayaan masyarakat terhadap media online ecommerce adalah dari semua variabel pada faktor personality hanya variabel pendidikkan saja yang tidak berpengaruh secara signifikan terhadap variabel tingkat kepercayaan media online ecommerce. Maka dapat disimpulkan bahwa pendidikkan merupakan variabel terpenting dalam pengaruhnya terhadap tingkat kepercayaan media online ecommerce.
Penyelidikan Karakteristik Mekanik Tarik Paduan Aluminium Magnesium (Al-Mg) Dengan Metode Pengecoran Konvensional
Authors: Kurniawan Fadly Ahmad , Isranuri Ikhwansyah
Published: June 2018

Pembuatan paduan Al-Mg dilakukan dengan menggunakan metode pengecoran. Komposisi paduan yang akan diteliti adalah 98% - 2%, 96% - 4%, dan 94% - 6% (perbandingan Aluminium - Magnesium). Dari hasil pengujian tarik didapatkan modulus elastisitas paduan Al-Mg dengan komposisi 98%-2% sebesar 4.44 GPa. Untuk paduan 96%-4% sebesar 4.46 GPa, dan untuk paduan 94%-6% sebesar 3.56 GPa. Hasil terbaik didapatkan dari komposisi 96%-4% yaitu sebesar 4,46 GPa.
Pengujian Pirolisis Kayu Dengan Metode Hampa Udara Untuk Memproduksi Bahan Bakar Gas
Authors: MT Yusrizal , Idris Muhammad
Published: June 2018

Perubahan iklim, pemanasan global dan krisis energi merupakan isu yang sangat mengkhawatirkan di dunia pada saat ini, sehingga harus dicarikan solusi secara cepat dan berkelanjutan. Energi alternatif dan energi terbarukan merupakan salah satu alternatif untuk penyelesaian persoalan tersebut. Penelitian dan pengembangan metode untuk penyelesaian persoalan tersebut merupakan hal yang sangat penting untuk dapat segera menggantikan bahan bakar fosil seperti minyak, gas dan batu bara. Negara Amerika Serikat, Uni Eropa dan Jepang sudah menginvestasikan anggaran yang sangat besar untuk mengembangkan teknologi energi terbarukan untuk biomassa. Mereka menargetkan basis pabrik komersial skala besar dan global. Di samping itu, di negara-negara berkembang, terutama daerah desa terpencil akses untuk mendapatkan listrik belum semua merata. Untuk mengurangi atau mencegah dampak pemanasan global dan meningkatkan kelistrikan di daerah desa terpencil, maka diperlukan sebuah teknologi baru untuk pirolisis kayu karet. Teknologi ini dibuat dengan biaya yang murah dan pemeliharaan yang mudah dalam pengoperasiannya untuk bisa menghasilkan bahan bakar gas yang bersih. Bahan bakar gas tersebut bisa digunakan langsung dengan Generator Set yang dikembangkan dalam skala laboratorium. Jurnal ini menginformasikan kinerja alat dan pengaruh beberapa parameter kinerjanya. Hasil penelitian ini dapat disimpulkan bahwa teknologi baru ini layak intuk diterapkan di daerah desa terpencil yang tidak dapat mengakses listrik dan peningkatan kinerja alat ini sangat memungkinkan untuk dikembangkan lebih baik lagi.
Teknik Watermarking Adaptif Menggunakan Micro Genetic Algorithm
Authors: Nurdin Hardisal , Zarlis Muhammad , Nababan Erna Budhiarti
Published: June 2018

Citra digital sangat rentan terhadap perlakuan pengolahan kembali, seperti pemampatan, penyaringan, pengaburan, dan sebagainya. Pada citra yang mengandung watermark, pengolahan kembali tentunya dapat merusak eksistensi watermark di dalamnya. Kekukuhan watermark dalam citra asli dapat ditingkatkan melalui pemilihan teknik-teknik penyisipan yang tepat. Salah satunya dengan menggunakan teknik transformasi citra seperti discrete wavelete transform atau DWT. Namun penentuan skala penyisipan (gain) bagi watermark menjadi sangat krusial, karena dengan nilai gain yang besar akan membuat kualitas visual citra dapat berkurang. Sebaliknya, nilai gain yang terlalu kecil membuat watermark akan sukar untuk dideteksi. Penggunaan teknik cerdas seperti micro genetic algorthm dapat memberika solusi dalam menentukan nilai penskalaan ini. Sehingga kualitas visual citra dapat dijaga dan watermark di dalamnya dapat dipertahankan.
Penyelidikan Karakteristik Mekanik Tarik Komposit Serbuk Kasar Kenaf
Authors: Kurniawan Fadly Ahmad
Published: June 2018

Tujuan penelitian ini adalah untuk memperoleh nilai tegangan, regangan dan modulus elastisitas dari spesimen komposit serbuk kasar kenaf dengan komposisi 90% Resin � 10% Serbuk, 80% Resin � 20% Serbuk dan 70% Resin � 30% Serbuk. Adapun nilai yang di dapat dari hasil pengujian tarik dari spesimen uji ini adalah untuk serbuk kasar 24,151 MPa, , regangan rata-rata serbuk kasar 2,533 MPa, modulus elastisitas sebesar 970,53MPa terhadap kekuatan uji tarik. Metode penelitian ini dilakukan di Laboratorium IFRC (Impact and Facture Research Center) Departemen Teknik Mesin Universitas Sumatera Utara. Komposit dibuat dengan menggunakan resin sebagai pengikat matriknya dan kenaf sebagai penguatnya. Variasi bahan adalah serbuk halus dan kasar 10%, 20% dan 30% resin 90%, 80% dan 70%. Spesimen di buat dengan metode paling sederhana (hand lay up). Selanjutnya komposit dibiarkan selama kurang lebih 24 jam agar hasilnya sesuai dengan yang di inginkan. Kemudian dilakukan proses pengujian tarik. Penelitiannya adalah spesimen yang telah diberi berbeda variasi diuji dengan mesin Uji Tarik. Hasil pengujian didapat kurva beban pertambahan panjang. Kemudian diperoleh hasil pada grafik untuk setiap spesimen.Luasan area ini adalah perbandingan dari tiap spesimen. Kemudian memperoleh hasil dengan luas area patah pada spesimen.
Analisa Penentuan Water Vapor Terhadap Pengaruh Erupsi Gunung Sinabung Menggunakan Data SUGAR Dan Citra Satelit Terra MODISs
Authors: Audah Safridatul , Cahyadi Mokhamad Nur , Taufik Muhammad
Published: June 2018

The eruption of Mount Sinabung in 2010 caused bursts of volcanic ash particles into the atmosphere layer to impact the weather. This is because volcanic ash is hydrocopic which can cause condensation process and block the process of solar radiation earth surface. Precivitable Water vapor (PWV) as one of the parameters of the atmosphere that can be used as information to determine the weather conditions in an area. Utilization of data Sumatran GPS Array (SUGAR) and data satellite Terra sensors MODIS (Moderate Resolution Imaging Spektroradiometer) can be used to find out PWV through GPS inversion method by utilizing estimated estimation of slowing and rotating GPS signals overlaid with troposphere. While the transmittance method is performed by comparing the surface reflectance between the channel absorption and the channel non absorption contained in the sensor MODIS. The results showed that spatial variation of PWV distribution pattern showed wetness pattern during eruption. This was indicated by some areas that have PWV distribution pattern almost in each region and PWV verification result from GPS showed � 47.65 mm-66.81 mm, while PWV value from MODIS ranges from � 13.02 mm - 80.05 mm. Based on the results of PWV-GPS correlation test from June to October of 2010 has a correlation coefficient of 0.0173 to PWV from MODIS and explains the positive relationship between PWV of GPS with PWV value from MODIS, but correlation value of the variable variables including low category because of location points Station SUGAR are spread unevenly and are more likely to spread along the western coast of Sumatra, which borders the Indian Ocean.
Analisa Kekuatan Impak Helmet Sepeda Motor Metode Impak Jatuh Bebas
Authors: Simanjuntak Rahmat Kartolo
Published: June 2018

The non-standard helmet testing is required for measure the helmet strength as effect of the load is given. In generally, traffic accident doesn�t involved by the velocity but also gravitational. Therefore, the research activity is done by researcher obtains the effect of free-fall impact loading on the non-standard helmet. The information which is obtained from this research will explain the effect of free-fall impact loading that is subjected on the non-standard helmet to user, industry, and also government. The objective of this research involves the testing apparatus construction of free-fall impact loading on the non-standard helmet, measuring the maximum impact loading, and the energy absorbing by helmet as effect of impact loading. The researcher collaborates with the Impact and Fracture Reaseach Center (IRFC) has bulit the testing apparatus which is equipped with good aquisition data system. The non-standar helmet is put on the adjustable testing rig. The impact time can be measured by eight inductive proximity sensors. The helmet will slide down and collides the anvil. The force will be measured with the load cell which is put down the anvil. There are four anvil forms which is adapted to the real condition, that is: flat plat, aligned plat, bullet, and a half-spherical anvil. The data will be transfered from the load cell into the DAQ system which has function to change the analog into digital signal. Finally, the data will be saved into PC as the force (N) and the impact time (ms). The free-fall impact testing equipment has shown the best performance on the force and impact time signal reading as long as the research activity. The maximum force on the flat anvil is 24.33 N; the aligned flat anvil is 37.88 N; the bullet anvil is 16.22 N; and a half-spherical anvil is 41.43 N at the elevation of 0.75 m. The minimum energy which causes the fracture on the helmet is 3.24 J at the elevation of 0.3 m.
Antibacterial, antibiofilm, hemolytic activity and phytochemical study of various aerial parts of Moringa oleifera in Pakistan
Authors: Dilawar Shahnaz , Shah Afzal , Khan Hidayat Ullah , Imad Saima
Published: June 2018

Theamethanolicoextractsaofffiveeaerial parts ofaMoringa oleifera Lamwwereascreened for their antibacterial, antibiofilm and hemolytic activity.”Theaphytochemical screening of the methanolic extracts of aerial parts was also evaluated. The antibacterial, antibiofilmiactivityiof the extractssof various aerial parts of M. oleifera was evaluated by disc diffusion and micro titer plate assay method against two selected bacterial species. Hemolyticaactivity of the methanoliciextracts was screened against normal human erythrocytes. Comparatively the methanolic extracts of all aerial parts were more effective against Gram positive bacteria Bacillus subtilis and Gram negative bacteria Escherichia coli (E. coli) .The present study suggests that all aerial parts of this plant can be used as an antibacterial, anti-biofilm agent in treating ailments caused by the tested organisms (Bacillus subtilis and Escherichia coli). Methanolic extracts of aerial parts possessed minimum hemolytic activity. Significant antimicrobial, antibiofilm activity of the extract was found in this study.Asian J. Med. Biol. Res. March 2018, 4(1): 77-85
The effect of the supplementation of lamb feed with Yucca schidigera on the lipid oxidation, color, physico-chemical and microbiological properties in meat
Authors: İMİK Halit , GÜMÜŞ Recep , ÖZLÜ Hayrunnisa , GELEN Sevda URÇAR , ATASEVER Meryem AYDEMİR
Published: June 2018

In this study, the effects of the supplementation of lamb rations with Yucca schidigera powder (YSP) on water activity, pH, lipid peroxidation, oxidation of colour parameters and microbial counts in the Musculus gluteo biceps and Musculus longissimus dorsi were investigated. Three groups were established, namely, the Control group fed on a basal ration and Groups YSPI and YSPII given a basal ration added 100 mg/kg and 200 mg/kg of Yucca schidigera powder, respectively. YSP affected pH and lipid peroxidation in the gluteo biceps and longissimus dorsi muscles, L* (Lightness) in the former and L* and a* (redness) in the latter. YSP reduced Enterobacteriaceae and total mesophilic aerobic bacteria counts in both muscles, while its effects on total psychrotrophic aerobic bacteria, Micrococcus/Staphylococcus, Staphylococcus aureus, yeast and mold counts varied. Prolonged storage negatively affected the quality of both muscles, but YSP provided significant amelioration. Dietary supplementation with YSP improved meat quality and shelf life.Asian J. Med. Biol. Res. March 2018, 4(1): 86-94
In vitro biofilm formation by multidrug resistant clinical isolates of Pseudomonas aeruginosa
Authors: Sanjee Sohana Al , Hassan Md Mahamudul , Manchur MA
Published: June 2018

In this study, 15 isolates of Pseudomonas aeruginosa were recovered in Cetrimide agar medium from aseptically collected swab samples. Antibiotic susceptibility test revealed highest resistance against Rifampicin (100%) followed by Penicillin (80%), Erythromycin (73.33%), Cephalosporin group (13.33-60%) and Aminoglycoside group (26.67%). The most effective group of antibiotic was Carbapenem with 6.67% resistance. Among 15 isolates, 3 were having highest Multiple Antibiotic Resistance (MAR) index were identified as Pseudomonas aeruginosa (P1, P2 and P3) by API®20NE microbial identification kit. Minimum inhibitory concentration (MIC) of the isolates P1, P2 and P3 was 3.05μg/mL, 0.76μg/mL and 3.05μg/mL for Meropenem whereas for Ceftriaxone it was 12.207μg/mL, 12.207μg/mL and 781.25μg/mL, respectively. Minimum bactericidal concentration (MBC) of Meropenem and Ceftriaxone was same for the isolates P1 and P2 i.e., 48.83μg/mL and 195.313μg/mL, respectively but in case of P3 it was 781.25μg/mL for both antibiotics. In case of 70% ethanol, the MIC and MBC was 1:4 dilutions (for isolate P3, MBC was 1:2 dilutions) whereas for Savlon®, MIC and MBC was 1% and 2% solution, respectively. All of the three isolates were biofilm former according to test tube assay and microtitre plate assay whereas modified congo red agar assay indicated only one isolate as biofilm former. The results suggest that post-operative wound infection may serve as a reservoir for multidrug resistant biofilm forming P. aeruginosa which may complicate the treatment regime unless proper treatment ensured based on antibiotic/antiseptic susceptibility test.Asian J. Med. Biol. Res. March 2018, 4(1): 105-116
Asian School of Nuclear Medicine – An Emerging Platform of Nuclear Medicine Education
Authors: Hasan Mizanul , Nasreen Faria
Published: June 2018

Abstract not available

Bangladesh J. Nuclear Med. 20(1): 7-8, January 2017
Hibernating Myocardium and Role of 18F FDG PET Cardiac Imaging – A review
Authors: Hussain Raihan
Published: June 2018

The term “Hibernation” is a challenging term but not infrequently used in Nuclear Cardiology. It often is used synonymously for tissue viability, although technically there are some differences. Viability is a prospective definition, but it does not imply evidence of functional recovery after interventions whereas hibernation is a retrospective definition based on evidence of functional recovery after interventions. But for practical clinical purposes both carries the similar meaning. The aim of this review article is to summarize our current understanding of the concept of hibernation and its clinical implications in patients with coronary artery disease (CAD) and the role of FDG PET study in its proper evaluation.

Bangladesh J. Nuclear Med. 20(1): 45-50, January 2017
Plenary Session
Authors: Hasan Mizanul
Published: June 2018

Abstract not available

Bangladesh J. Nuclear Med. 20(1): 71-90, January 2017
Risk of bleeding with direct oral anticoagulants versus warfarin: cohort studies using primary care datasets
Authors: Vinogradova Yana , Coupland Carol , Hippisley-Cox Julia
Published: June 2018

Background

There is limited evidence on the safety of direct oral anticoagulants (DOACs) in real world settings.

Aim

To investigate risks of bleeding and all-cause mortality in DOACs compared to warfarin.

Method

Prospective cohorts of incident oral anticoagulant users between 2011 and 2016 derived from two UK databases (QResearch and CPRD) linked to hospital and mortality data, with no anticoagulant prescriptions in the year before entry, were selected. Overall, 132,231 warfarin, 7744 dabigatran, 37,863 rivaroxaban, and 18,223 apixaban users, were sub-grouped into those with atrial-fibrillation (AF) and without (non-AF), followed up until any major bleed leading to hospital admission or death. Analyses were adjusted for demographics, life style, comorbidities and prescribed medications.

Results

Compared to warfarin, apixaban was associated with decreased risk of major bleeding (hazard ratio 0.62, 95% confidence interval [CI] = 0.54 to 0.73), intracranial (HR 0.48, 95% CI = 0.34 to 0.68) and gastro-intestinal (HR 0.67, 95% CI = 0.54 to 0.83). Dabigatran and rivaroxaban were associated with decreased risk of intracranial bleeding (HR 0.44, 95% CI = 0.27 to 0.71; HR 0.73, 95% CI = 0.59 to 0.90). Rivaroxaban was associated with increased risk of all-cause mortality (HR 1.34, 95% CI = 1.26 to 1.42), consistent for both sub-cohorts. A small increased all-cause mortality risk for apixaban (HR 1.14, 95% CI = 1.05 to 1.24) was statistically significant on the lower doses (HR 1.31, 95% CI = 1.19 to 1.45) but not on higher doses (HR 0.98, 95% CI = 0.87 to 1.10).

Conclusion

Overall, apixaban was found to be the safest drug for any major bleed, particularly for patients with increased risk of intracranial or gastro-intestinal bleeding.

Funding

This work has been supported by NIHR with a SPCR round 11 grant [reference number 304]. We acknowledge the contribution of EMIS, CPRD, HES and Office of National Statistics for providing the data.
An observational study assessing high dose opioid prescribing and associated adrenal insufficiency
Authors: Hayhoe Sophie , Rudland Simon , Morris Damian
Published: June 2018

Background

Long-term opioid use is known to affect endocrine function, with case reports indicating an association with adrenal insufficiency.

Aim

This study aims to investigate long-term, high-dose opioid use (≥80mg morphine or equivalent per day) at a Suffolk (UK) General Practice and its effect on adrenal function.

Method

From a practice list of 18,300, retrospective data was collected for patients prescribed high-dose opioids for non-cancer pain for at least three months on current repeat prescription. Patient demographics and prescribing information were collected using SystmOne. Cortisol levels in the high-dose opioid patients, and short synacthen testing if indicated, were performed.

Results

The 35 identified patients (0.2% of practice list) were predominantly female (77%) ≥70 years old (37%), and taking opioids prescribed for osteoarthritis or back pain (77%). 6% were prescribed >280mg morphine or equivalent per day, with one patient prescribed 705 mg. Routine evaluation for development of adrenal suppression and subsequent management was poor. 31% (11 of 35) had developed symptoms potentially indicative of adrenal insufficiency. One of these patients was among the 21% (7 of 35) with suppressed serum cortisol. Adrenal insufficiency secondary to opioids was confirmed in one patient using short synacthen testing. There was no statistical difference in either opioid dose or months of use for those with or without early morning cortisol suppression.

Conclusion

The investigation highlights both the considerable use of high-dose opioids for non-malignant pain and their apparent association with adrenal suppression, demonstrating the need for formal guidelines to aid recognition and diagnosis.
The changing role of GP clinicians working in community hospitals.
Authors: Seamark David , Davidson Deborah , Tucker Helen , Ellis-Paine Angela , Glasby Jon
Published: June 2018

Background

In 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.

Aim

What models of medical care exist in English community hospitals today and what factors are driving changes?

Method

Interviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.

Results

Seventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.

Conclusion

Multiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.
The usefulness of health education materials in GP waiting rooms: a cross-sectional study
Authors: Maskell Katherine , McDonald Paula , Paudyal Priyamvada
Published: June 2018

Background

More than half of patients in the UK wait between 5 and 15 minutes before seeing the GP, and this time in the waiting room (WR) provides an ideal opportunity for patient education.

Aim

To assess patients’ perceptions of the usefulness, noticeability and attractiveness of health education materials (HEMs); and the variety, number, topics, design and accessibility of these HEMs.

Method

An anonymous questionnaire was distributed to patients in the WR to assess their use of health information and perceptions of HEMs. A survey measured the availability of HEMs in the WR and evaluated their quality against 16 accessibility and design criteria.

Results

A total of 556 questionnaires were completed (response rate 97.9%). On average, WRs contained 72 posters covering 23 topics, and 53 leaflets covering 24 topics. Multivariate analysis showed that patients’ perception of usefulness was significantly associated with reading in the WR, using written HEMs, and not having a university degree; whilst noticeability was associated with reading in the WR, and being female. Attractiveness was associated with not having a university degree and shorter waiting time.

Conclusion

This study suggests that a wide variety of HEMs are available, and that many patients find them useful and noticeable, however, fewer find them well-designed and attractive. Future research should focus on the effectiveness of generally available HEMs at changing knowledge, attitudes, intentions, and behaviours; and utilising technology to deliver innovative means of providing patient health information.
The incidence of diagnostic errors in UK primary care and implications for health care, research, and medical education: a retrospective record analysis of missed diagnostic opportunities
Authors: Cheraghi-Sohi Sudeh , Holland Fiona , Reeves David , Campbell Stephen , Esmail Aneez , Morris Rebecca , Small Nicola , de Wet Carl , Singh Hardeep ,   NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre
Published: June 2018

Background

Diagnostic errors have recently been identified as a high-priority patient safety problem in primary care by the World Health Organization (WHO). However, no studies exist in UK to quantify the extent of such errors and associated harm in primary care.

Aim

This study aimed to determine the incidence of ‘missed diagnostic opportunities’ (MDOs) in UK primary care.

Method

Retrospective reviews of electronic health records (EHRs). Twenty-one general practices were recruited, sampled by size and deprivation. Pairs of GP-reviewers independently reviewed 100 randomly selected face-to-face consultations with adults in each practice (n = 21), reviewing a 12-month period for consultations containing new diagnostic activity. Records were jointly reviewed where at least one reviewer identified an MDO to gain consensus.

Results

We reviewed 2070 EHRs; and, 1530 contained some new diagnostic activity. After joint review, at least one clinician thought an MDO was likely/certain in 4.4% (95% CI = 3.2 to 5.8) of these consultations, and both rated an MDO likely/certain in 2.5% (95% CI = 1.6 to 3.9). Final consensus, identified MDO occurrences for 61.4% of the consultations. The overall agreement was higher than other comparable studies (κ statistic 0.68), and 54% (n = 20) of the mutually agreed MDOs (n = 56), were rated as likely to cause moderate or severe patient harm.

Conclusion

In this first assessment of MDOs in UK primary care, we found their frequency to be relatively low but human cost relatively high for over half of those experiencing an error. Identifying workable strategies to prevent errors occurring from the identified contributing factors, and prioritising diagnostic errors is the next critical action.
Effective safety netting in acute childhood illness: an important contribution to avoiding preventable deaths
Authors: Neill Sarah , Roland Damian , Thompson Matthew , Palmer-Hill Sue , Bayes Natasha , Mullins Laura , Turner Tracy , Tavaré Alison , Lakhanpaul Monica
Published: June 2018

Background

Children’s use of urgent care services continues to increase. If families are to access the right services at the right time they need access to information to inform their decision making. Providing a safety net of information has the potential to reduce morbidity and avoidable mortality and has been shown to reduce re-consultation safely.

Aim

Our research programme aims to provide parents with information they can use to help them determine when to seek help for an acutely ill child.

Method

Our programme includes: ASK SARA, a systematic review of existing interventions; ASK PIP, qualitative exploration of safety netting information used by parents and professionals; ASK SID, development of the content and delivery modes for the intervention; ASK ViC, video capture of children with acute illness; and ASK Petra, safety netting tool development using consensus methodology.

Results

The ASK SNIFF programme findings demonstrate the need for professionally endorsed and co-produced safety netting resources focussing on symptoms of acute childhood illness. We now have consensus on the scripted content for a safety netting tool supported by video materials to enable parents to see symptoms for real.

Conclusion

Safety netting tools are a valuable aid to general practice enabling GPs to show parents what to look out for when their child is sick so that they know when to (re)consult. Recent reports of failure to recognise and appropriately safety net children with sepsis highlights the importance of such tools.
‘I’m not sure if there is any point to all this doc?’: a qualitative study into GPs responses to existential questions
Authors: Appleby Alistair , Swinton John , Wilson Philip
Published: June 2018

Background

Very few studies address how GPs react to situations where patients express doubt or perplexity about the meaning of their existence.

Aim

To assess the range of responses which GPs make to a theoretical scenario, where a patient says ‘Doc, I’m not sure there is any point to all this?’. To discuss the significance of these responses within a clinical and philosophical context.

Method

We interviewed 19 GPs in Scotland and analysed transcripts using an approach informed by grounded theory.

Results

The context of these questions, patients’ other complaints, and the comfort of the GP in this area of discussion, affected the GP response. Responses included discomfort and diverting the conversation, exploring the contribution of physical pain, or, most commonly, considering the questioning to indicate mental health problems. Some GPs felt the questioning was fuelled by unmet emotional needs or by social and relational crises. GP responses included prescribing medication or pragmatic ‘just get on with it’ suggestions to the perceived unknowability of rational answers. Other GPs considered this represented a philosophical question worthy of legitimate debate and response, or with therapeutic potential.

Conclusion

This raises questions about whether existential questioning, is best regarded as pathological, normative or potentially therapeutic. Our study indicates that GPs own philosophy and approach may define the scope of the discussion and therapeutic options. Consultations which permit legitimate existential discussion, while considering a wide range of health associations, generate the greatest range of therapeutic approaches, but further work on outcomes is justified.
Influenza vaccination uptake in an Irish obstetric cohort
Authors: Barrett Tina , Drew R , O’Reilly F , O’Carroll A , O’Shea A , McEntee E , Cleary B
Published: June 2018

Background

Influenza infection during pregnancy can lead to significant maternal morbidity. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.

Aim

The objectives of this study were to determine: the uptake of influenza vaccination during pregnancy; the determinants of vaccination uptake; knowledge, attitudes and concerns of postnatal women surrounding vaccination during pregnancy; and the recommendations of healthcare workers. Pertussis vaccination uptake was also determined.

Method

A standardised 24 item questionnaire was distributed to postnatal women between January and June 2016. Questions focused on maternal characteristics, vaccination status, sources of information, and reasons for receiving / declining the vaccine. The role of the healthcare professional in recommending and offering vaccination was addressed.

Results

330 surveys were disseminated, there was a 60% response rate. Of the 198 surveys, 109 (55.1%) respondents were vaccinated against Influenza and 64 (32.3%) against Pertussis. Women in the professional/manager/employer socioeconomic group were more likely to be vaccinated (aOR 3.4; 95% CI 1.11–10.42). There was a strong association between vaccination uptake and receiving information during pregnancy (aOR 12.8; 95% CI 2.65–62.5) and receiving the vaccine in a previous pregnancy (aOR 5.15; 95% CI 1.70–15.62). Unvaccinated women had concerns about the harm it may cause to their baby (53%; n=30) and concerns about side effects for themselves (55%; n=33).

Conclusion

A key determinant of vaccination was provision of information and a recommendation to vaccinate by a healthcare professional. Uncertainty over safety of the vaccine was evident. Consistent patient education by healthcare professionals could increase vaccine uptake.
WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams
Authors: Bekkering Trudy , Aertgeerts Bert , Kuijpers Ton , Vermandere Mieke , Burgers Jako , Kunnamo Ilkka , Vandvik Per
Published: June 2018

Background

The WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.

Aim

To share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.

Method

In March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.

Results

We are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.

Conclusion

The WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.
Patient consent to medical students in general practice
Authors: Webb Matthew , Thirlwall Sarah , McKinley Bob
Published: June 2018

Background

Informed consent is required for active participation of patients in medical education. At Keele Medical School, we require practices to advertise that they teach undergraduate students and to obtain appropriate patient consent at various stages of the patient journey.

Aim

The study aimed to explore patients’ experience of consent to involvement in undergraduate medical education in general practice.

Method

During the final year at Keele University Medical School, students undertake a patient satisfaction survey. A questionnaire was attached to the reverse of this survey during the academic year 2016–2017. The questionnaire explored the stage of the patient journey consent was obtained, whether they were offered an alternative appointment and how comfortable they were with medical students being involved in their care.

Results

A total of 489 questionnaires were completed covering 62 GP practices. 97% of patients reported that consent was obtained at least once during their encounter and the majority reported that this occurred at booking. 98% of patients were comfortable or very comfortable with a medical student leading their consultation. However, 28% of those surveyed stated that they were either not given the option of not seeing the student or there was no other alternative appointment available.

Conclusion

The results indicate that in the vast majority of cases patient consent is obtained at least once during their attendance. Patients expressed a high level of satisfaction with medical students’ involvement in their care. Further work is required to evaluate the role of the data as a marker of individual practice teaching quality.
How can we improve hepatitis B testing and management in primary care? A cross-sectional survey of GPs in England, 2015–2017
Authors: Amin Z , Beebeejaun K , Letley L , Mahange B , Harrington K , Checkley J , Edelstein M
Published: June 2018

Background

Chronic hepatitis B (HBV) infection can lead to life-threatening liver disease. In the UK, approximately 180,000 people are carriers. The disease is underdiagnosed and undertreated.

Aim

As part of a nurse-led intervention aimed at improving HBV contact-tracing and management, we ascertained GPs’ understanding of HBV and their perceived barriers and enablers to HBV diagnosis.

Method

In 2015, we asked 1324 GPs across 2 England regions about HBV-related knowledge and practice, using a questionnaire. We reported the proportion of GPs answering each question, with 95% confidence intervals (95% CI).

Results

254 GPs (18%) replied. Of those, 189(74%, 95%CI 68–79%) correctly identified hepatitis B surface antigen as a marker of current HBV infection, and 154 (61%, 95% CI = 54 to 66%) recognised IgM anti-HBc as a marker for differentiating acute from chronic cases. 219 GPs (86%, 95% CI = 81 to 90%) believed HBV knowledge among patients to be one of the main enablers to improved testing uptake and 208 (82%, 95% CI = 77 to 86%) identified lack of HBV knowledge among patients as a barrier to testing. Of all GP responders, 227 (89%, 95% CI = 85 to 93%) reported HBV training and education would be beneficial, and 185 (73%, 95% CI = 67 to 78%) reported knowledge of treatment options as a knowledge gap.

Conclusion

GPs perceive gaps in knowledge among patients and healthcare professionals as a factor potentially contributing to the under-ascertainment of chronic hepatitis B in England. Improving HBV awareness and knowledge among patients, their contacts, and increasing HBV-focused training for GPs, particularly in the interpretation of laboratory results and the treatment options, can improve case ascertainment and chronic HBV management in primary care.
Integrated care: learning from East London
Authors: Bussu Sonia
Published: June 2018

Background

Despite a growing body of literature on integrated, there remains a relatively small evidence base to suggest which elements of integrated care are most effective and how to implement them successfully. This might also be due to the fact that policy thinking around integrated care is struggling to translate into organisation change at the point of delivery. Better understanding of patterns of collaborations and integrated pathways is crucial to understand frontline staff’s OD needs and provide adequate support.

Aim

This paper focuses on the frontline level to assess progress towards integrated care in East London.

Method

We use admission avoidance (Rapid Response service) and discharge services (Discharge to Assess) as a lens to examine how frontline staff from secondary care, community health services and social service work together to deliver more integrated care. The study uses the Researcher in Residence (RiR), where the researcher is embedded in the in the organisations she is evaluating, as a key member of the delivery team.

Results

Initial findings suggest that while work on integrated care has enabled some level of collaborative working at strategic levels in partner organisations, on the frontline professionals are grappling with issues such as professional identity, professional boundaries, mutual trust and accountability, as new services and roles struggle to be fully embedded within the local health system.

Conclusion

The paper sheds light on to the complexity on integrated care at the point of delivery. Better understanding of integrated care pathways is crucial to evidence patterns of collaboration across organisations; assess how these new roles and teams are embedding themselves within the local health economy; identify organisation development needs; and provide adequate support to frontline staff.
Changing attitudes to childhood immunisation in English parents
Authors: Yarwood Joanne , Letley Louise
Published: June 2018

Background

Sustained vaccine coverage is essential to protect the population against vaccine-preventable diseases. It requires high level of confidence in the national vaccine programme.

Aim

We surveyed parental attitudes to childhood vaccinations in 2015 and compared them to attitudes in the previous 10 years.

Method

We randomly selected 275 locations in England. Interviewers identified eligible carers of children aged <5 years and interviewed them. The questionnaire covered all aspects of the immunisation process, vaccines administered in pregnancy and from infancy to pre-school with a maximum of 86 mixed questions.

Results

1792 parents were interviewed. Confidence in the vaccination programme was high. Only 2% of parents reported refusing vaccination whilst 90% reported vaccinating their children automatically when due. 97% of parents consulted web-based resources for information on vaccination. Parents who used chat rooms or discussion forums for this purpose were significantly more likely to say they had seen something that would make them doubt having their child(ren) immunized (31% compared to 8% amongst all parents). Health professionals and the NHS were seen as the most trusted source of advice on immunisation (90% agreed/strongly agreed with each). Very few parents did not trust these sources (4% and 3% disagreed, respectively).

Conclusion

Health professionals remain extremely important in communicating information about vaccination and are highly trusted by parents; a trust that has increased in recent years. Despite most parents seeking information on the Internet, trust in and advice from health care professionals appeared to be key factors influencing parental decisions.
Sharing a methodology to develop a satisfaction questionnaire in mental health care
Authors: Ma Eva , Johnson Rachael , Hagan Teresa , Young Alex , Dhanjal Rajinder , Claridge Dannielle , Davies Shon , Boyce Christopher , Glennon Marcus , Backhouse Catherine , Fletcher Harriet , Kay Catharine , Woods Sarah
Published: June 2018

Background

This paper outlines a multi-method’ process for developing a satisfaction questionnaire (SQ) for completion by service users. Satisfaction is a mark of service quality. Both health and social care services are required to evidence this. Working collaboratively with those who use our services is essential for achieving transformation in healthcare.

Aim

In developing a SQ, the aim was to collaboratively identify key quality criteria of most importance to service users and carers.

Method

In the absence of a gold standard methodology for developing a SQ, we developed an iterative multimethod’ phased process. Phase 1 involved a focus group, attended by service users and carers (n = 20). Participants at the focus group developed a preliminary list of quality criteria. Phase 2 involved a review of existing feedback questionnaires to supplement our quality criteria, including the Friends & Family Test. Phase 3 aimed to build consensus to refine the criteria, using a process informed by the Delphi technique with participants from a service user forum. The final phase of refinement is now underway.

Results

Preliminary findings highlight the key quality indicators of a high-quality service, as defined by service users and carers.

Conclusion

It is useful to adopt and develop an iterative multi-method’ approach involving co-production and consensus building in developing a valid and meaningful SQ.
Multimodal noncontact atomic force microscopy and Kelvin probe force microscopy investigations of organolead tribromide perovskite single crystals
Authors: Almadori Yann , Moerman David , Martinez Jaume Llacer , Leclère Philippe , Grévin Benjamin
Published: June 2018

In this work, methylammonium lead tribromide (MAPbBr3) single crystals are studied by noncontact atomic force microscopy (nc-AFM) and Kelvin probe force microscopy (KPFM). We demonstrate that the surface photovoltage and crystal photostriction can be simultaneously investigated by implementing a specific protocol based on the acquisition of the tip height and surface potential during illumination sequences. The obtained data confirm the existence of lattice expansion under illumination in MAPbBr3 and that negative photocarriers accumulate near the crystal surface due to band bending effects. Time-dependent changes of the surface potential occurring under illumination on the scale of a few seconds reveal the existence of slow ion-migration mechanisms. Lastly, photopotential decay at the sub-millisecond time scale related to the photocarrier lifetime is quantified by performing KPFM measurements under frequency-modulated illumination. Our multimodal approach provides a unique way to investigate the interplay between the charges and ionic species, the photocarrier-lattice coupling and the photocarrier dynamics in hybrid perovskites.
Genetic Mapping of Milling Quality Traits in Lentil (Lens culinaris Medik.)
Authors: Subedi Maya , Bett Kirstin E. , Khazaei Hamid , Vandenberg Albert
Published: June 2018

Milling qualities are key traits for the red lentil (Lens culinaris Medik.) industry as price is largely determined by dhal recovery yield. Dhal milling involves removal of the seed coat and splitting of the cotyledon to produce either splits or footballs (cotyledons still attached). The objectives of the study were to determine the heritability of the milling traits dehulling efficiency (DE), milling recovery (MR), and football recovery (FR) and to identify the genomic regions controlling them. We used a lentil recombinant inbred population from the cross ‘CDC Robin’ × ‘946a‐46’, which have contrasting seed characteristics. The mapping population consists of 127 F7–derived lentil recombinant inbred lines that were phenotyped for milling quality parameters from four site–years in Saskatchewan, Canada. A total of 534 single nucleotide polymorphism markers, seven simple sequence repeat markers, and four morphological markers were used for quantitative trait locus (QTL) mapping. The broad‐sense heritability was moderate for DE and MR and relatively low for FR. Milling quality traits were significantly correlated with seed shape (seed diameter and seed plumpness). Multiple QTLs for milling traits were detected in six of seven linkage groups (LGs). The most stable QTLs governing DE and MR were clustered on LGs 1, 2, 3, and 7, whereas FR QTLs were clustered on LGs 4, 5, 6, and 7. The molecular markers identified for these traits could be used for improving milling quality in lentil breeding programs.