bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing the effectivity of the mixed virtual reality training Into D’mentia for informal caregivers of people with dementia: protocol for a longitudinal, quasi-experimental study
Authors: Jütten Linda Helena , Mark Ruth Elaine , Maria Janssen Ben Wilhelmus Jacobus , Rietsema Jan , Dröes Rose-Marie , Sitskoorn Margriet Maria
Published: August 2017

Introduction

Informal caregivers for people with dementia (hereafter: caregivers) often feel (over)burdened by the care for a loved one with dementia, and this can have various deleterious effects on both caregivers and patients. Support for caregivers is urgently needed, and for this reason, a dementia simulator (Into D’mentia) was developed in which caregivers experience what it is like to have dementia. The simulator attempts to heighten caregivers’ empathy and understanding for the patient and, in turn, diminish their own caregiver burden. The current study evaluates whether the simulator is effective on a number of outcomes.

Methods and analysis

A longitudinal, quasi-experimental study is ongoing in the Netherlands. We aim to recruit 142 caregivers in total divided over two groups: 71 caregivers in the intervention group and 71 caregivers in the control group. All participants will complete interviews and questionnaires at four time points: at baseline, 1 week, 2.5 months and 15 months after the training. The primary outcomes include empathy, caregiver burden, caregiver’s sense of competence, social reliance, anxiety, depression and caregivers’ subjective and objective health.

Ethics and dissemination

This study is being carried out in agreement with the Declaration of Helsinki, and the protocol has been approved by the local ethics committees.

Registration details

This study is registered with The Netherlands National Trial Register (NNTR5856).
The relationship between ambulatory blood pressure variability and enlarged perivascular spaces: a cross-sectional study
Authors: Yang Shuna , Qin Wei , Yang Lei , Fan Huimin , Li Yue , Yin Jiangmei , Hu Wenli
Published: August 2017

Objectives

Recent studies reported that 24-hour ambulatory blood pressure variability (ABPV) was associated with lacunar infarction and white matter hyperintensities (WMH). However, the relationship between ABPV and enlarged perivascular spaces (EPVS) has not been investigated. Thus, our study aimed to investigate whether ABPV is associated with EPVS by 24-hour ambulatory blood pressure monitoring (ABPM).

Design

We conducted this study as a cross-sectional study.

Settings

The study was based on patients who presented for physical examinations in our hospital from May 2013 to June 2016.

Participants

Patients with both brain MRI scans and 24-hour ABPM were included and patients with acute stroke, a history of severe stroke and some other severe diseases were excluded. A total of 573 Chinese patients were prospectively enrolled in this study.

Primary and secondary outcome measures

EPVS in basal ganglia (BG) and white matter (WM) were identified on MRI and classified into three categories by the severity. WMH were scored by the Fazekas scale. Coefficient of variation (CV) and SD were considered as metrics of ABPV. Spearman correlation analysis and ordinal logistic regression analysis were used to assess the relationship between ABPV and EPVS.

Results

There were statistical differences among the subgroups stratified by the severity of EPVS in BG in the following ABPV metrics: SD and CV of systolic blood pressure (SBP), CV of diastolic blood pressure (DBP) in 24 hours, daytime and nighttime and SD of DBP in nighttime. The above ABPV metrics were positively associated with the degree of EPVS. The association was unchanged after adjusting for confounders. Spearman correlation analysis showed ABPV was not related to the degree of EPVS in the WM.

Conclusion

ABPV was independently associated with EPVS in BG after controlling for blood pressure, but not in the WM. Pathogenesis of EPVS in BG and WM might be different.
Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study
Authors: Razum Oliver , Reiss Katharina , Breckenkamp Jürgen , Kaufner Lutz , Brenne Silke , Bozorgmehr Kayvan , Borde Theda , David Matthias
Published: August 2017

Objective

Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness).

Design

Cross-sectional study.

Setting

Three obstetric hospitals in Berlin, Germany.

Methods

Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters.

Results

The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94).

Conclusions

We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).
Comparing perceived clarity of information on overdiagnosis used for breast and prostate cancer screening in England: an experimental survey
Authors: Ghanouni Alex , Renzi Cristina , McBride Emily , Waller Jo
Published: August 2017

Objectives

‘Overdiagnosis’, detection of disease that would never have caused symptoms or death, is a public health concern due to possible psychological and physical harm but little is known about how best to explain it. This study evaluated public perceptions of widely used information on the concept to identify scope for improving communication methods.

Design

Experimental survey carried out by a market research company via face-to-face computer-assisted interviews.

Setting

Interviews took place in participants’ homes.

Participants

2111 members of the general public in England aged 18–70 years began the survey; 1616 were eligible for analysis. National representativeness was sought via demographic quota sampling.

Interventions

Participants were allocated at random to receive a brief description of overdiagnosis derived from written information used by either the NHS Breast Screening Programme or the prostate cancer screening equivalent.

Primary and secondary outcome measures

The primary outcome was how clear the information was perceived to be (extremely/very clear vs less clear). Other measures included previous exposure to screening information, decision-making styles and demographic characteristics (eg, education). Binary logistic regression was used to assess predictors of perceived clarity.

Results

Overdiagnosis information from the BSP was more likely to be rated as more clear compared with the prostate screening equivalent (adjusted OR: 1.43, 95% CI 1.17 to 1.75; p=0.001). Participants were more likely to perceive the information as more clear if they had previously encountered similar information (OR: 1.77, 1.40 to 2.23; p<0.0005) or a screening leaflet (OR: 1.35, 1.04 to 1.74; p=0.024) or had a more ‘rational’ decision-making style (OR: 1.06, 1.02 to 1.11; p=0.009).

Conclusions

Overdiagnosis information from breast screening may be a useful template for communicating the concept more generally (eg, via organised campaigns). However, this information may be less well-suited to individuals who are less inclined to consider risks and benefits during decision-making.
The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes: a nationwide population-based study from Taiwan
Authors: Kuo Chin-Sung , Chen Yung-Tai , Hsu Chien-Yi , Chang Chun-Chin , Chou Ruey-Hsing , Li Szu-Yuan , Kuo Shu-Chen , Huang Po-Hsun , Chen Jaw-Wen , Lin Shing-Jong
Published: August 2017

Objectives

The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013.

Design

This study was retrospective, longitudinal and propensity score-matched.

Setting Nationwide claims data for the period 2000–2013 were retrieved from Taiwan’s National Health Insurance Research Database.

Participants

The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection.

Main outcome measures

Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality.

Results

During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95% CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95% CI 0.56 to 0.67), heart failure (aHR=0.50; 95% CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95% CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications.

Conclusions

Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.
Safety of ceftriaxone in paediatrics: a systematic review protocol
Authors: Zeng Linan , Choonara Imti , Zhang Lingli , Xue Song , Chen Zhe , He Miaomiao
Published: August 2017

Introduction

Ceftriaxone is widely used in children in the treatment of sepsis. However, concerns have been raised about the safety of ceftriaxone, especially in young children. The aim of this review is to systematically evaluate the safety of ceftriaxone in children of all age groups.

Methods and analysis

MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and adverse drug reaction (ADR) monitoring systems will be systematically searched for randomised controlled trials (RCTs), cohort studies, case–control studies, cross-sectional studies, case series and case reports evaluating the safety of ceftriaxone in children. The Cochrane risk of bias tool, Newcastle-Ottawa and quality assessment tools developed by the National Institutes of Health will be used for quality assessment. Meta-analysis of the incidence of ADRs from RCTs and prospective studies will be done. Subgroup analyses will be performed for age and dosage regimen.

Ethics and dissemination

Formal ethical approval is not required as no primary data are collected. This systematic review will be disseminated through a peer-reviewed publication and at conference meetings.

PROSPERO registration number

CRD42017055428.
Psychometric properties of the Chinese version of the WHOQOL-HIV BREF to assess quality of life among people living with HIV/AIDS: a cross-sectional study
Authors: Zhu Yaxin , Liu Jie , Qu Bo
Published: August 2017

Objectives

This study aims to assess the psychometric properties of the Chinese version of the WHOQOL-HIV BREF.

Design

Cross-sectional study.

Setting

Centers for Disease Control and Prevention and infectious disease hospitals in three Chinese provinces.

Participants

Sample of 1100 people living with HIV/AIDS (PLWHA).

Interventions

We recruited 1100 PLWHA to evaluate their quality of life (QOL) using the WHOQOL-HIV BREF. Of these participants, 57 were randomly selected to repeat the QOL evaluation 2 weeks later.

Main outcome measures

The reliability of the WHOQOL-HIV BREF was assessed in terms of its internal consistency and test–retest reliability. The construct, concurrent, convergent, discriminant and known-group validity were also analysed. In addition, the factorial invariance across genders was assessed.

Results

Cronbach’s α coefficient for the overall scale was 0.93. Except for the spirituality domain, which had an α below 0.70 (0.66), the other five domains showed adequate internal consistency. The test–retest reliability revealed a statistically significant intraclass correlation coefficient of 0.72–0.82 (p<0.001). Confirmatory factor analysis found that the six-domain structure produced an acceptable fit to the data. The instrument showed factorial invariance across gender groups. All domains were significantly correlated with the general items and the SF-36 (p<0.01). The correlation coefficients were >0.40 (r=0.40–0.67), except for the association between the spirituality domain and two general items (QOL: r=0.33; health status: r=0.36). Subjects with lower CD4 counts had lower scores for all domains (p<0.05). Symptomatic participants had significantly lower scores than asymptomatic participants on the physical, psychological and independence domains (p<0.05).

Conclusions

The WHOQOL-HIV BREF revealed good psychometric characteristics among Chinese PLWHA. These findings offer promising support for the use of the WHOQOL-HIV BREF as a measure of QOL among Chinese PLWHA and in cross-cultural comparative studies on QOL.
Distinguishing variation in referral accuracy from referral threshold: analysis of a national dataset of referrals for suspected cancer
Authors: Burton Christopher D , McLernon David J , Lee Amanda J , Murchie Peter
Published: August 2017

Objectives

To distinguish between variation in referral threshold and variation in accurate selection of patients for referral in fast-track referrals for possible cancer. To examine factors associated with threshold and accuracy and model the effects of changing thresholds.

Design

Analysis of national data on cancer referrals from general practices in England over a 5-year period. We developed a new method to estimate specificity of referral to complement existing sensitivity. We used bivariate meta-analysis to produce summary measures and described practices in relation to these.

Setting

5479 general practitioner (GP) practices with data relating to more than 50 cancer cases diagnosed over the 5 years.

Outcomes

Number of practices whose 95% confidence regions for sensitivity and specificity indicated that they were outliers in terms of either referral threshold or decision accuracy.

Results

2019 practices (36.8%) were outliers in relation to referral threshold compared with 1205 practices (22%) in relation to decision accuracy. Practice age profile, cancer incidence and deprivation showed a modest association with decision accuracy but not with thresholds. If all practices shared the referral behaviour of those in the highest quintile of age-standardised referral rate, there would be a 3.3% increase in cancers detected through fast-track pathways at the cost of a 36.9% increase in urgent referrals.

Conclusion

This new method permits variation in referral to be described more precisely and quality improvement activities to be targeted. Changing referral thresholds without increasing accuracy will result in modest effects on detection rates and a large increase in demand on diagnostic services.
Caesarean sections and private insurance: systematic review and meta-analysis
Authors: Hoxha Ilir , Syrogiannouli Lamprini , Braha Medina , Goodman David C , da Costa Bruno R , Jüni Peter
Published: August 2017

Objective

Financial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Embase and The Cochrane Library from the first year of records through August 2016.

Eligibility criteria

We included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women.

Outcomes

The prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance.

Results

Eighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ2=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ2=0.011).

Conclusions

Caesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.
Protocol for a randomised, placebo-controlled pilot study for assessing feasibility and efficacy of faecal microbiota transplantation in a paediatric ulcerative colitis population: PediFETCh trial
Authors: Pai Nikhil , Popov Jelena
Published: August 2017

Introduction

Ulcerative colitis (UC) is a chronic, relapsing condition characterised by colonic inflammation. Increasing prevalence in early-age diagnosis provides opportunities for additional complications in later life as a result of prolonged exposure to inflammatory and therapeutic insults, necessitating novel avenues for therapeutics which may result in fewer side effects. Faecal microbiota transplantation (FMT) has previously demonstrated potential therapeutic benefit in an adult randomised-controlled trial and several recurrentClostridium difficileinfection studies. This phase Ib pilot will be the first randomised, single-blinded, placebo-controlled trial to assess feasibility and patient outcomes in a paediatric inflammatory bowel disease (IBD) population.

Methods and analysis

Fifty patients will be randomised 1:1 to receive normal saline control or active sample. Enema administrations will be performed two times per week for 6 weeks, followed at a 6-month follow-up period. Feasibility outcomes will include measures of patient eligibility, recruitment, willingness to participate, samples collections, hospitalizations and drop-out rate. Improvements in disease symptoms will determine the efficacy of treatment. Clinical disease scores will be taken throughout the study period using the Paediatric Ulcerative Colitis Activity Index (PUCAI). Monitoring of inflammatory markers in blood and stool will be performed at regular intervals. Microbiome analysis will be conducted on stool samples collected throughout the trials period. Imaging and endoscopic surveillance will be conducted if clinically necessary.

Ethics and dissemination

Ethics was obtained from local hospital research ethics boards across all three sites. Health Canada and FDA approval was obtained for the use of an Investigatory New Drug product. Results from this trial will be presented in international conferences and published in peer-review journals.

Trial registration number

Trial registration number:NCT02487238; preresults.
Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol
Authors: Hanlon Peter , Yeoman Lynsey , Esiovwa Regina , Gibson Lauren , Williamson Andrea E , Mair Frances S , Lowrie Richard
Published: August 2017

Introduction

People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals.

Methods and analysis

Seven electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials, Assia, Scopus, PsycINFO and CINAHL) will be searched from 1960 (or inception) to October 2016 and supplemented by forward citation searching, handsearching of reference lists and searching grey literature. Two reviewers will independently review titles, abstract and full-texts using DistillerSR software. Inclusion criteria include (1) homeless adults with any physical LTC, (2) interventions delivered by a healthcare professional (any professional trained to provide any form of healthcare, but excluding social workers and professionals without health-related training), (3) comparison with usual care or an alternative intervention, (4) report outcomes such as healthcare usage, physical and psychological health or well-being or cost-effectiveness, (5) randomised controlled trials, non-randomised controlled trials, controlled before-after studies. Quality will be assessed using the Cochrane EPOC Risk of Bias Tool. A meta-analysis will be performed if sufficient data are identified; however, we anticipate a narrative synthesis will be performed.

Ethics and dissemination

This review will synthesise existing evidence for interventions delivered by healthcare professionals to manage physical LTCs in adults who are homeless. The findings will inform the development of future interventions and research aiming to improve the management of LTCs for people experiencing homelessness. Ethical approval will not be required for this systematic review as it does not contain individual patient data. We will disseminate the results of this systematic review via conference presentations, healthcare professional networks, social media and peer-reviewed publication.

Trial registration number

PROSPERO registration number: CRD42016046183.
Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm
Authors: Opmeer Brent C , Hollingworth William , Marques Elsa M R , Margelyte Ruta , Gunnell David
Published: August 2017

Objectives

To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm.

Design

Retrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data.

Setting

A large hospital in South West England.

Subjects

Patients attending the ED for self-harm.

Interventions

Extension of the LPS’ working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investment

Main outcome measures

Number and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance.

Results

298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (−£84; 95% CI −£254 to £77).

Conclusions

The extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS’ working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation.
Effect of national implementation of utstein recommendation from the global resuscitation alliance on ten steps to improve outcomes from Out-of-Hospital cardiac arrest: a ten-year observational study in Korea
Authors: Kim Young Taek , Shin Sang Do , Hong Sung Ok , Ahn Ki Ok , Ro Young Sun , Song Kyoung Jun , Hong Ki Jeong
Published: August 2017

Objectives

The Utstein ten-step implementation strategy (UTIS) proposed by the Global Resuscitation Alliance, a bundle of community cardiopulmonary resuscitation (CPR) programs to improve outcomes after out-of-hospital cardiac arrests (OHCAs), has been developed. However, it is not documented whether UTIS programs are associated with better outcomes or not. The study aimed to test the association between the UTIS programme and better outcomes after OHCA.

Methods

The study was a before- and after-intervention study. Adults OHCAs treated by emergency medical service (EMS) from 2006 to 2015 in Korea were collected, excluding patients witnessed by ambulance personnel and without outcomes. Phase 1 (2009–2011) after implementing three programs (national OHCA registry, obligatory CPR education, and public report of OHCA outcomes), and phase 2 (2012–2015) after implementing two programs (telephone-assisted CPR and EMS quality assurance programme) were compared with the control period (2006–2008) when no UTIS programme were implemented. The primary outcome was good neurological recovery (cerebral performance scale 1 or 2). We tested the association between the phases and outcomes, adjusting for confounders using a multivariate logistic regression model to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Results

A total of 1 28 888 eligible patients were analysed. The control, phase 1, and phase two study groups were 19.4%, 30.5%, and 50.0% of the whole, respectively. There were significant changes in pre-hospital ROSC (0.8% in 2006 and 7.1% in 2015), survival to discharge (3.0% in 2006 and 6.1% in 2015), and good neurological recovery (1.2% in 2006 and 4.1% in 2015). The AORs (95% CIs) for good neurological recovery were 1.82 (1.53–2.15) or phase 1 and 2.21 (1.78–2.75) for phase two compared with control phase.

Conclusion

The national implementation of the five UTIS programs was significantly associated with better OHCA outcomes in Korea.
Patient and system factors of time to surgery after hip fracture: a scoping review
Authors: Sheehan Katie J , Sobolev Boris , Villán Villán Yuri F , Guy Pierre
Published: August 2017

Objectives

It is disputed whether the time a patient waits for surgery after hip fracture increases the risk of in-hospital death. This uncertainty matters as access to surgery following hip fracture may be underprioritised due to a lack of definitive evidence. Uncertainty in the available evidence may be due to differences in characteristics of patients, their injury and their care. We summarised the literature on patients and system factors associated with time to surgery, and collated proposed mechanisms for the associations.

Methods

We used the framework developed by Arksey and O’Malley and Levacet alfor synthesis of factors and mechanisms of time to surgery after hip fracture in adults aged >50 years, published in English, between 1 January 2000 and 28 February 2017, and indexed in MEDLINE, EMBASE, CINAHL or Ageline. Proposed mechanisms for reported associations were extracted from discussion sections.

Results

We summarised evidence from 26 articles that reported on 24 patient and system factors of time to surgery post hip fracture. In total, 16 factors were reported by only one article. For 16 factors we found proposed mechanisms for their association with time to surgery which included surgical readiness, available resources, prioritisation and out-of-hours admission.

Conclusions

We identified patient and system factors associated with time to surgery after hip fracture. This new knowledge will inform evaluation of the putative timing–death association. Future interventions should be designed to influence factors with modifiable mechanisms for delay.
Assessing residents’ knowledge of patient satisfaction: a cross-sectional study at a large academic medical centre
Authors: Stewart Diana E , Dang Bich N , Trautner Barbara , Cai Cecilia , Torres Sergio , Turner Teri
Published: August 2017

Objectives

Patient satisfaction impacts healthcare quality and outcomes. Residents play an important role in patient satisfaction at academic institutions. This study aims to assess residents’ patient satisfaction knowledge and determine which learning experiences contributed to their knowledge acquisition.

Settings

This study was conducted at a health science university in a large, urban, tertiary-care academic medical centre in the USA.

Participants

All residents from internal medicine (n=185) and paediatrics (n=156) were asked to participate.

Design

Residents completed a survey from April 2013 to December 2013 that assessed (1) knowledge of factors that impact patient satisfaction and (2) learning experiences that may have contributed to their understanding of the drivers of patient satisfaction (eg, experiential (personal or clinical) or didactics). Trainees identified the importance of factors in determining patient satisfaction on a five-point Likert scale; answers were compiled into a knowledge score. The score was correlated with prior personal/clinical experience and didactics.

Results

Of the 341 residents, 247 (72%) completed the survey. No difference was found in knowledge among training levels or residency programme. More than 50% incorrectly thought physician board certification, patient’s education, patient’s income and physician’s age impacted satisfaction. Personal experience, through hospitalisation of a relative or friend, was correlated with higher knowledge (67% vs 71%, p=0.03). Ninety-nine per cent (n=238) stated peer observation, and all stated faculty feedback impacted their patient satisfaction knowledge. Seventy-seven per cent (n=185) had attended didactics on satisfaction, but attendance did not correlate with higher scores.

Conclusions

Our study showed trainees have a few gaps in their patient satisfaction knowledge, and attending past educational sessions on patient satisfaction did not correlate with higher knowledge scores. Our data suggest that academic centres should leverage residents’ personal experiences, their observations of peers and faculty feedback to enhance patient satisfaction knowledge.
Redundant systematic reviews on the same topic in surgery: a study protocol for a meta-epidemiological investigation
Authors: Katsura Morihiro , Kuriyama Akira , Tada Masafumi , Yamamoto Kazumichi , Furukawa Toshi A
Published: August 2017

Introduction

We are witnessing an explosive increase in redundant and overlapping publications of systematic reviews and meta-analyses (SRs/MAs) on the same topic, which often present conflicting results and interpretations, in the current medical literature. They represent wasted efforts on the part of investigators and peer reviewers and may confuse and possibly mislead clinicians and policymakers. Here, we present a protocol for a meta-epidemiological investigation to describe how often there are overlapping SRs/MAs on the same topic, to assess the quality of these multiple publications, and to investigate the causes of discrepant results between multiple SRs/MAs in the field of major surgery.

Methods and analysis

We will use MEDLINE/PubMed to identify all SRs/MAs of randomised controlled trials (RCTs) published in 2015 regarding major surgical interventions. After identifying the ‘benchmark’ SRs/MAs published in 2015, a process of screening in MEDLINE will be carried out to identify the previous SRs/MAs of RCTs on the same topic that were published within 5 years of the ‘benchmark’ SRs/MAs. We will tabulate the number of previous SRs/MAs on the same topic of RCTs, and then describe their variations in numbers of RCTs included, sample sizes, effect size estimates and other characteristics. We will also assess the differences in quality of each SR/MA using A Measurement Tool to Assess Systematic Reviews (AMSTAR) score. Finally, we will investigate the potential reasons to explain the discrepant results between multiple SRs/MAs.

Ethics and dissemination

No formal ethical approval and informed consent are required because this study will not collect primary individual data. The intended audiences of the findings include clinicians, healthcare researchers and policymakers. We will publish our findings as a scientific report in a peer-reviewed journal.

Trial registration number

In PROSPERO CRD42017059077, March 2017.
Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults
Authors: Skou Søren Thorgaard , Lind Martin , Hölmich Per , Jensen Hans Peter , Jensen Carsten , Afzal Muhammad , Jørgensen Uffe , Thorlund Jonas Bloch
Published: August 2017

Introduction

Arthroscopic surgery is a very common orthopaedic procedure. While several trials have investigated the effect of knee arthroscopy for middle-aged and older patients with meniscal tears, there is a paucity of trials comparing meniscal surgery with non-surgical treatment for younger adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears.

Methods and analysis

This is a protocol for a multicentre, parallel-group RCT conducted at six hospitals across all five healthcare regions in Denmark. 140 patients aged 18–40 years with a clinical history and symptoms consistent with a meniscal tear, verified on MRI, found eligible for meniscal surgery by an orthopaedic surgeon will be randomly allocated to one of two groups (1:1 ratio). Participants randomised to surgery will undergo either arthroscopic partial meniscectomy or meniscal repair followed by standard postsurgical care, while participants allocated to exercise and education will undergo a 12-week individualised, supervised neuromuscular and strengthening exercise programme and patient education. The primary outcome will be difference in change from baseline to 12 months in the mean score on four Knee Injury and Osteoarthritis Outcome Score subscales, covering pain, symptoms, function in sports and recreation and quality of life (Knee Injury and Osteoarthritis Outcome Score (KOOS4)) supported by the individual subscale scores allowing clinical interpretation. Alongside, the RCT an observational cohort will follow patients aged 18–40 years with clinical suspicion of a meniscal tear, but not fully eligible or declining to participate in the trial.

Ethics and dissemination

Results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Regional Committees on Health Research Ethics for Southern Denmark.

Registration details

ClinicalTrials.gov (NCT02995551).
Radiation dose from common radiological investigations and cumulative exposure in children with cystic fibrosis: an observational study from a single UK centre
Authors: Ward Rebecca , Carroll William D , Cunningham Paula , Ho Sheng-Ang , Jones Mary , Lenney Warren , Thompson David , Gilchrist Francis J
Published: August 2017

Objectives

Cumulative radiation exposure is associated with increased risk of malignancy. This is important in cystic fibrosis (CF) as frequent imaging is required to monitor disease progression and diagnose complications. Previous estimates of cumulative radiation are outdated as the imaging was performed on older equipment likely to deliver higher radiation. Our objectives were to determine the radiation dose delivered to children during common radiological investigations using modern equipment and to identify the number of such investigations performed in a cohort of children with CF to calculate their cumulative radiation exposure.

Design, setting and participants

Data including age at investigation and radiation exposure measured as estimated effective dose (EED) were collected on 2827 radiological studies performed on children at one UK paediatric centre. These were combined with the details of all radiological investigations performed on 65 children with CF attending the same centre to enable calculation of each child’s cumulative radiation exposure.

Results

The mean EED for the common radiological investigations varied according to age. The range was 0.01–0.02 mSv for chest X-rays, 0.03–0.11 mSv for abdominal X-rays, 0.57–1.69 mSv for CT chest, 2.9–3.9 mSv for abdominal and pelvic CT, 0.20–0.21 mSv for sinus CT and 0.15–0.52 mSv for fluoroscopy-guided procedures. The mean EED was three to five times higher for helical compared with axial chest CT scans. The mean annual cumulative EED for our cohort of children with CF was 0.15 mSv/year with an estimated cumulative paediatric lifetime EED (0–18 years) of 3.5 mSv.

Conclusions

This study provides up-to-date estimations of the radiation exposure when using common radiological investigations. These doses and the estimates of cumulative radiation exposure in children with CF are lower than previously reported. This reflects the reduced EED associated with modern equipment and the use of age-specific scanning protocols.
Disseminating START: training clinical psychologists and admiral nurses as trainers in a psychosocial intervention for carers of people with dementia’s depressive and anxiety symptoms
Authors: Lord Kathryn , Rapaport Penny , Cooper Claudia , Livingston Gill
Published: August 2017

Objectives

To put into practice and to evaluate an initial dissemination programme for the Strategies for Relatives (START), a clinically and cost-effective manualised intervention for family carers of people with dementia.

Setting

We offered 3-hour ‘train-the-trainer’ sessions through the British Psychological Society and Dementia UK.

Participants

Clinical psychologists and admiral nurses across the UK.

Primary and secondary outcome measures

After the training session, attendees completed an evaluation. Attendees were asked how they had implemented START 6 and 12 months later, and to participate in telephone interviews about their experiences of what helps or hinders implementation 1 year after training.

Results

We trained 134 clinical psychologists and 39 admiral nurses through 14 training sessions between October 2014 and September 2015 in nine UK locations and made materials available online. The 40 survey respondents had trained 75 other staff. By this time, 136 carers had received START across 11 service areas. Findings from 13 qualitative interviews indicated that some clinical psychologists had begun to implement START, facilitated by buy-in from colleagues, existing skills in delivering this type of intervention, availability of other staff to deliver the intervention and support from the research team. Admiral nurses did not supervise other staff and were unable to cascade the intervention. Where START has not been used, common barriers included lack of staff to deliver the intervention and family carer support not being a service priority. Participants wanted the training to be longer.

Conclusions

We trained clinical psychologists and admiral nurses to deliver and implement START locally. Results from survey respondents show that it was cascaded further and used in practice in some areas, but we do not know whether START was implemented by non-respondents. Future dissemination requires management buy-in, availability of practitioners and supervisors and consideration of other ways of delivery.
Living with chronic migraine: a qualitative study on female patients' perspectives from a specialised headache clinic in Spain
Authors: Palacios-Ceña Domingo , Neira-Martín Beatriz , Silva-Hernández Lorenzo , Mayo-Canalejo Diego , Florencio Lidiane Lima , Fernández-de-las-Peñas César , García-Moreno Héctor , García-Azorín David , Cuadrado María Luz
Published: August 2017

Objectives

The aim of this study was to explore the views and experiences of a group of Spanish women suffering from chronic migraine (CM).

Setting

Headache clinic at a university hospital in Madrid (Spain).

Participants

Purposeful sampling of patients that attended a specialised headache clinic for the first time between June 2016 and February 2017 was performed. The patients included were females aged 18–65 and with positive diagnoses of CM according to the International Classification of Headache disorders (third edition, beta version), with or without medication overuse. Accordingly, 20 patients participated in the study with a mean age of 38.65 years (SD 13.85).

Design

Qualitative phenomenological study.

Methods

Data were collected through in-depth interviews, researchers’ field notes and patients’ drawings. A thematic analysis was performed following appropriate guidelines for qualitative research.

Results

Five main themes describing the significance of suffering emerged: (a) the shame of suffering from an invisible condition; (b) treatment: between need, scepticism and fear; (c) looking for physicians’ support and sincerity and fighting misconceptions; (d) limiting the impact on daily life through self-control; and (e) family and work: between understanding and disbelief. The disease is experienced as an invisible process, and the journey to diagnosis can be a long and tortuous one. Drug prescription by the physician is greeted with distrust and scepticism. Patients expect sincerity, support and the involvement of their doctors in relation to their disease. Pain becomes the main focus of the patient’s life, and it requires considerable self-control. The disease has a strong impact in the work and family environment, where the patient may feel misunderstood.

Conclusions

Qualitative research offers insight into the way patients with CM experience their disease and it may be helpful in establishing a more fruitful relationship with these patients.
Early childhood health in Bielefeld, Germany (BaBi study): study protocol of a social-epidemiological birth cohort
Authors: Spallek Jacob , Grosser Angelique , Höller-Holtrichter Chantal , Doyle Ina-Merle , Breckenkamp Jürgen , Razum Oliver
Published: August 2017

Introduction

The heterogeneity among the German population is increasing. Sociodemographic differentials (eg, in education and migrant status) have been associated with health disparities. Life course studies show that a considerable part of these disparities is determined by exposures during pregnancy and early childhood. The BaBi study was established in 2012 to investigate the production of health disparities from foetal life to childhood in the city of Bielefeld, Germany.

Methods and analysis

Between 2013 and 2016, detailed information on socioeconomic characteristics, migration background, lifestyle factors, environmental factors, healthcare use, and health status of 995 newborns, including 24 twins, and their families was collected using standardised instruments. Data collection started during pregnancy or shortly after birth with a computer-assisted personal interview of the pregnant woman/mother. Follow-up data will be collected until 2018 by computer-assisted telephone interviews around the first, second and after the third birthday of the child and by linking routine healthcare data. Blood samples are collected from a small subsample of 50 mothers for a substudy about stress during pregnancy (BaBi-Stress study).

Ethics and dissemination

The study was approved by the ethical committee of the Medical Faculty of Muenster University and the Data Protection Board of Bielefeld University. Results will be published in scientific journals. Data sets and questionnaires will be made accessible for researchers based on access proposals and data usage contracts.
Cr doped ZnO nanostructures: synthesis, electronic structures, and magnetic properties
Authors: Murphy Michael W. , Diebel William R. , Yiu Yun-Mui , Sham Tsun-Kong
Published: August 2017

In this experiment, we have attempted to dope Cr into ZnO nanostructure as a function of dopant concentration using sol-gel method, followed by controlled thermal annealing with some success. We have also examined the samples thus prepared with scanning electron microscopy (SEM), X-ray powder diffraction (XRD), near edge X-ray absorption fine structure (NEXAFS), both theoretical and experimental, and magnetic measurements. We found that low concentration of Cr can indeed be doped in ZnO and is substitutional, occupying the tetrahedral site. However, upon increasing dopant concentration and annealing temperature, a secondary phase with Cr occupying an octahedral site precipitates out, which was evident from SEM, XRD, and NEXAFS. Ferromagnetism at room temperature was not observed in any samples, although at low Cr concentration and 400 °C processing temperature, antiferromagnetism can be seen; however, at higher concentrations or processing temperatures, the samples show only paramagnetism.
Bonding properties of FCC-like Au44(SR)28 clusters from X-ray absorption spectroscopy
Authors: Yang Rui , Chevrier Daniel M. , Zeng Chenjie , Jin Rongchao , Zhang Peng
Published: August 2017

Thiolate-protected gold clusters with precisely controlled atomic composition have recently emerged as promising candidates for a variety of applications because of their unique optical, electronic, and catalytic properties. The recent discovery of the Au44(SR)28 total structure is considered as an interesting finding in terms of the face-centered cubic (FCC)-like core structure in small gold-thiolate clusters. Herein, the unique bonding properties of Au44(SR)28 is analyzed using temperature-dependent X-ray absorption spectroscopy (XAS) measurements at the Au L3-edge and compared with other FCC-like clusters such as Au36(SR)24 and Au28(SR)20. A negative thermal expansion was detected for the Au–Au bonds of the metal core (the first Au–Au shell) and was interpreted based on the unique Au core structure consisting of the Au4 units. EXAFS fitting results from Au28(SR)20, Au36(SR)24, and Au44(SR)28 show a size-dependent negative thermal expansion behavior in the first Au–Au shell, further highlighting the importance of the Au4 units in determining the Au core bonding properties and shedding light on the growth mechanism of these FCC-like Au clusters.