bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous Ultrasound Gastrostomy: A Novel Device and Bedside Procedure for Gastrostomy Tube Insertion Using Magnetic and Ultrasound Guidance
Authors: Gentry Wilkerson R. , Pustavoitau Aliaksei , Carolan Howard , Benner Nolan , Fischer Clark , Sheets Daniel J. , Wang Peggy I. , Tropello Steven
Published: February 2019

This paper describes a novel percutaneous ultrasound gastrostomy (PUG) procedure and the CoapTech point-of-care ultrasound magnet-aligned gastrostomy (PUMA-G) device, which were developed to allow the placement of gastrostomy tubes by physicians across a variety of specialties, using ultrasound equipment found in many nonspecialized medical locations while consuming fewer resources. The current practice for the placement of gastrostomy tubes requires highly specialized equipment and trained physicians, which can delay the performance of the procedure or make it inaccessible in some locations. The PUMA-G device consists of an orogastric catheter with a balloon that encloses a magnetic bar at its distal end and an external, handheld magnet. The orogastric tube is passed through the mouth or the nose and into the stomach. The external magnet is then used to maneuver the balloon to the desired location in the stomach, with feedback and guidance from real-time ultrasound visualization. The novelty of this approach is the use of magnets to create the static compressive force needed for coaptation, in which the stomach is pushed flush against the abdominal wall, allowing ultrasound visualization of the entire gastrostomy tract (skin to stomach), safe cutaneous puncture, and guidewire-assisted placement of the gastrostomy tube. The development of the PUMA-G device has been aided by benchtop and simulation testing in addition to canine and human cadaver studies. The PUMA-G device was used successfully in 29 of 30 cadaver tests, with the one failure attributed to operator error and not the device. Further testing in live patients will assess the safety of the procedure, the speed with which it can be completed, the cost savings, and other benefits the device might offer over the existing gastrostomy procedures.
Adaptive array reduction method for acoustic beamforming array designs
Authors: Arcondoulis Elias J. G. , Liu Yu
Published: February 2019

This letter presents a modification to a very recent iterative microphone removal array design process, called the Array Reduction Method (ARM). The ARM iteratively reduces an array based on the product of sidelobe and main lobe criteria, yet the main lobe may become distorted and the beamformer output can disproportionately favor one of the criteria. The Adaptive Array Reduction Method presented here uses the derivative estimates of the maximum sidelobe level and main lobe width with respect to the number of microphones removed, and the distortion of the main lobe during iteration, to produce an improved source image map.
On the choice of grasp type and location when handing over an object
Authors: Cini F. , Ortenzi V. , Corke P. , Controzzi M.
Published: February 2019

During a handover, passers prefer precision grasps and grasp purposive parts of objects, leaving “handles” free for receivers.
Biology, biography, and the translational gap
Authors: Summers-Trio Pamela , Hayes-Conroy Allison , Singer Burton , Horwitz Ralph I.
Published: February 2019

Medicine-based evidence integrates biology and biography to help eliminate the translational gap between research and the clinic.
A killer sidekick for antitumor T cells
Authors: Hinrichs Christian S.
Published: February 2019

Engineered NK cells kill myeloid-derived suppressor cells to aid CAR-T cell antitumor responses.
Outcome of a giant coronary artery mycotic pseudoaneurysm secondary to non-typhoidSalmonellamanaged without surgical intervention
Authors: Haque Husham , Zohourian Hajir
Published: February 2019

A 48-year-old woman with a history of AIDS, a recent coronary artery bypass graft operation and prior bacteraemia with non-typhoidSalmonellapresented with non-exertional chest pain and elevated troponins. The cardiac catheterisation and coronary CT angiography revealed a 9 cm pseudoaneurysm arising from the proximal left anterior descending artery. The blood cultures confirmed non-typhoidSalmonella. Emergent surgery was initially deferred due to her complex anatomy. Moreover, the hospital course was complicated by Epstein-Barr virus meningitis and an associated decline in the patient’s mentation. Consequently, the mycotic pseudoaneurysm was medically managed with antibiotics and strict blood pressure goals. The natural history of giant mycotic coronary artery pseudoaneurysm formation and progression is appreciated through this first reported medically managed case. The follow-up coronary CT angiography at 3 months showed evidence of pseudoaneurysm leakage into surrounding tissue. The patient expired at 5 months from an unknown cause.
Nitrous oxide myelopathy with functional vitamin B12deficiency
Authors: Williamson John , Huda Saif , Damodaran Dinesh
Published: February 2019

Recreational use of nitrous oxide as a ‘legal high’ is increasing in the UK. Physicians should be ‘street wise’ to this increasing prevalence and aware of the potential neurological complications which may result from misuse. We describe a 17-year-old male patient who presented to neurology with a severe myelopathy following prolonged recreational use of nitrous oxide. MRI demonstrated characteristic changes affecting the dorsal columns and blood tests demonstrated a ‘functional’ B12deficiency. Clinical and radiological improvement was noted following initiation of vitamin B12replacement.
Bilateral maxillary palatal talon cusps in deciduous central incisors
Authors: AlHumaid Jehan
Published: February 2019

‘Talon cusp’ is a developmental dental disturbance characterised by a cuspal projection in the cingulum area or cementoenamel junction, with normal enamel and dentin containing varying degrees of pulp tissue. The prevalence of talon cusp varies with race, age and the criteria used for diagnosis. It has been reported in the maxillary and mandibular arches of both the deciduous and permanent dentitions. The prevalence of the talon cusp in the deciduous dentition is reported to be 2.1% in Saudi Arabian subjects. The purpose of this paper is to report the rare bilateral presence of talon cusps on the deciduous maxillary central incisors of a 4-year-old female patient with a family history of consanguineous marriage.
Allergic bronchopulmonary aspergillosis presumably unmasked by PD-1 inhibition
Authors: Donato Anthony A , Krol Ronald
Published: February 2019

Programmed cell death-1 (PD-1) inhibitors stimulate immune recognition of tumour cells in cancer patients, but have significant autoimmune side effects including pneumonitis. We report the case of a patient with asthma and mild eosinophilia who developed unusual pulmonary side effect of bronchiectasis, severe eosinophilia (absolute eosinophil count: 3200 c/mm3) and elevated IgE levels (7050 IU/mL; normal: <164 IU/mL) 4 months into therapy with the PD-1 inhibitor pembrolizumab. Aspergillus fumigatus IgG was elevated at 15.60 U/mL (normal: <12.01 U/mL). He responded to therapy with corticosteroids and voriconazole and was able to resume pembrolizumab thereafter with good clinical response.
Disseminated CMV infection and HLH in a patient with well-controlled HIV and ulcerative colitis
Authors: Cockbain Beatrice Clare , Mora Peris Borja , Abbara Aula , So Chun Wah , Cooke Graham
Published: February 2019

We present a case of haemophagocytic lymphohistiocytosis (HLH) in the context of disseminated cytomegalovirus (CMV) viraemia in a 50-year-old man with well-controlled HIV infection and ulcerative colitis (UC), for which he was receiving azathioprine. Peak CMV viral load was 371 000 copies/ml with evidence of end-organ CMV in the lungs and colon. A bone marrow biopsy showed evidence of haemophagocytosis of platelets, neutrophils and erythrocytes. The azathioprine was stopped, and he received intravenous ganciclovir and corticosteroids with suppression of the CMV viral load and resolution of the HLH.
Dopamine agonist-responsive Cushing’s disease
Authors: Anand Gurpreet , Bink Andrea , Beuschlein Felix , Schmid Christoph
Published: February 2019

A 47-year-old Caucasian man was referred to our clinic with a severe clinical and biochemical phenotype of endogenous hypercortisolism for further evaluation and treatment. In addition to confirming adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome, we found left temporal hemianopsia, massively increased prolactin, increased growth hormone/insulin-like growth factor 1 values, hypogonadotropic hypogonadism and central hypothyroidism. As the cause of these abnormalities we revealed an invasive macroadenoma of the pituitary secreting ACTH, prolactin and growth hormone, resulting not only in a clinically predominant picture of Cushing’s syndrome but also causing hypogonadotropic hypogonadism and central hypothyroidism. The patient responded surprisingly well to dopamine agonist treatment leading not only to normalisation of prolactin levels but also to clinical and biochemical remission of Cushing’s syndrome. Tumour size decreased successively in follow-up MRI scans. Despite lacking immunohistochemical analysis of tumour tissue, we assume plurihormonal secretion of ACTH, prolactin and growth hormone from pituitary macroadenoma, which fortunately responded well to dopamine agonist treatment.
Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial
Authors: Gulliford Martin C , Prevost A Toby , Charlton Judith , Juszczyk Dorota , Soames Jamie , McDermott Lisa , Sultana Kirin , Wright Mark , Fox Robin , Hay Alastair D , Little Paul , Moore Michael V , Yardley Lucy , Ashworth Mark
Published: February 2019

Objectives

To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.

Design

Open label, two arm, cluster randomised controlled trial.

Setting

UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.

Participants

79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.

Interventions

AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.

Main outcome measures

Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.

Results

The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89 (95% confidence interval 0.68 to 1.16) and 0.88 (0.78 to 0.99, P=0.04), respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years (adjusted rate ratio 0.84, 95% confidence interval 0.75 to 0.95), with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years (adjusted rate ratio 0.96, 95% confidence interval 0.82 to 1.12) or people aged 85 years and older (0.97, 0.79 to 1.18); there was also no evidence of an increase in serious bacterial complications (0.92, 0.74 to 1.13).

Conclusions

Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation.

Trial registration

ISRCTN95232781.
Technologies of trust in epidemic response: openness, reflexivity and accountability during the 2014–2016 Ebola outbreak in West Africa
Authors: Ryan Molly J , Giles-Vernick Tamara , Graham Janice E
Published: February 2019

Trust is an essential component of successful cooperative endeavours. The global health response to the 2014–2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities and responders during the epidemic. Social scientists affiliated with the Ebola 100-Institut Pasteur project interviewed approximately 160 local, national and international responders holding a wide variety of roles during the epidemic. Focusing on responder’s experiences of communities’ trust during the epidemic, this qualitative study identifies and explores social techniques for effective emergency response. The response required individuals with diverse knowledges and experiences. Responders’ included on-the-ground social mobilisers, health workers and clinicians, government officials, ambulance drivers, contact tracers and many more. We find that trust was fostered through open, transparent and reflexive communication that was adaptive and accountable to community-led response efforts and to real-time priorities. We expand on these findings to identify ‘technologies of trust’ that can be used to promote actively legitimate trustworthy relationships. Responders engaged the social technologies of openness (a willingness and genuine effort to incorporate multiple perspectives), reflexivity (flexibly responsive to context and ongoing dialogue) and accountability (taking responsibility for local contexts and consequences) to facilitate relations of trust. Technologies of trust contribute to the development of a framework of practical techniques to improve the acceptance and effectiveness of future emergency response strategies
Intraoperative evoked potential monitoring for detecting cerebral injury during adult aneurysm clipping surgery: a systematic review and meta-analysis of diagnostic test accuracy
Authors: Zhu Fang , Chui Jason , Herrick Ian , Martin Janet
Published: February 2019

Objectives

We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms.

Design

Systematic review.

Data sources

Major electronic databases including MEDLINE, EMBASE, LILACS.

Eligibility criteria

We included studies that reported the DTA of intraoperative EP monitoring during intracranial aneurysm clipping procedures in adult patients.

Data extraction and synthesis

After quality assessment, we performed a meta-analysis using the bivariate random effects model, and calculated the possible range of DTA point estimates using a new best-case/worst-case scenario approach to quantify the impact of rescue intervention on DTA.

Results

A total of 35 studies involving 4011 patients were included. The quality of the primary studies was modest and the heterogeneity across studies was high. The pooled sensitivity and specificity for predicting postoperative neurological deficits for the somatosensory evoked potential (SSEP) monitoring was 59% (95% CI: 39% to 76%; I2: 76%) and 86% (95% CI: 77% to 92%; I2: 94%), for motor evoked potential (MEP) monitoring was 81% (95% CI: 58% to 93%; I2: 54%) and 90% (95% CI: 86% to 93%; I2: 81%), and for combined SSEP and MEP monitoring was 92% (95% CI: 62% to 100%) and 88% (95% CI: 83% to 93%). The best-case/worst-case range for the pooled point estimates for sensitivity and specificity for SSEP was 50%–63% and 81%–100%, and for MEP was 59%–74% and 93%–100%, and for combined SSEP and MEP was 89%–94% and 83%–100%.

Conclusions

Due to the modest quality and high heterogeneity of the existing primary studies, it is not possible to confidently support or refute the diagnostic value of EP monitoring in cerebral aneurysm clipping surgery. However, combined SSEP and MEP appears to provide the best DTA for predicting postoperative stroke. Contrary to popular assertion, the modest sensitivity of SSEP monitoring is not explained by the use of rescue intervention.

PROSPERO registration number

CRD42015016884.
Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus: a retrospective cohort study
Authors: Wu Jiayue , Zhang Wei-Hong , Ma Jinghang , Bao Chunde , Liu Jinlin , Di Wen
Published: February 2019

Objective

To develop a predictive model for fetal loss in women with systemic lupus erythematosus (SLE).

Design

A retrospective cohort study.

Setting

Data were collected in a tertiary medical centre, located in Shanghai, China, from September 2011 to May 2017.

Participants

338 pregnancies with SLE were analysed retrospectively. Cases of multiple pregnancy and those in which artificial abortion was performed for personal reasons were excluded.

Primary outcome measures

Fetal loss was the primary outcome. A stepwise regression to identify the predictors related to the fetal loss and coefficient B of each variable was used to develop a predictive model and make a corresponding risk classification. The Hosmer-Lemeshow test, Omnibus test and area under the receiver-operating characteristic curve (AUC) were used to assess the goodness-of-fit and discrimination of the predictive model. A 10-fold cross validation was used to assess the model for overfitting.

Results

Unplanned pregnancies (OR 2.84, 95% CI 1.12 to 7.22), C3hypocomplementemia (OR 5.46, 95% CI 2.30 to 12.97) and 24 hour-urinary protein level (0.3≤protein<1.0 g/24 hours: OR 2.10, 95% CI 0.63 to 6.95; protein≥1.0 g/24 hours: OR 5.89, 95% CI 2.30 to 15.06) were selected by the stepwise regression. The Hosmer-Lemeshow test resulted in p=0.325; the Omnibus test resulted in p<0.001 and the AUC was 0.829 (95% CI 0.744 to 0.91) in the regression model. The corresponding risk score classification was divided into low risk (0–3) and high risk groups (>3), with a sensitivity of 60.5%, a specificity of 93.3%, positive likelihood ratio of 9.03 and negative likelihood ratio of 0.42.

Conclusions

A predictive model for fetal loss in women with SLE was developed using the timing of conception, C3complement and 24 hour-urinary protein level. This model may help clinicians in identifying women with high risk pregnancies, thereby carrying out monitoring or/and interventions for improving fetal outcomes.
Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey
Authors: Xu Dong Roman , Hu Mengyao , He Wenjun , Liao Jing , Cai Yiyuan , Sylvia Sean , Hanson Kara , Chen Yaolong , Pan Jay , Zhou Zhongliang , Zhang Nan , Tang Chengxiang , Wang Xiaohui , Rozelle Scott , He Hua , Wang Hong , Chan Gary , Melipillán Edmundo Roberto , Zhou Wei , Gong Wenjie
Published: February 2019

Introduction

Primary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.

Methods and analysis

1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.

Ethics and dissemination

This study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.
Association between depression and overweight in Chinese adolescents: a cross-sectional study
Authors: Zhao Zhongyi , Ding Ning , Song Shenzhi , Liu Yang , Wen Deliang
Published: February 2019

Objective

Based on a nationally representative adolescent sample, we examined the association of depression on the prevalence of overweight or obesity and whether this association was moderated by gender.

Methods

There were 1081 adolescents from the China Family Panel Studies that participated in our study. Depression in adolescents was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordered logistic regression model was used to quantify its association with overweight or obesity. Analyses were performed for the total group, and separately for males and females.

Results

The prevalence of depression in Chinese adolescents was 23.22%. Depression (CES-D ≥16) was significantly associated with overweight or obesity (OR=1.47, 95% CI: 1.14 to 1.91, p=0.004) after adjustment for personal, household and regional confounders. Among four subdimensions of depression, depressed affect and lack of positive affect were significantly associated with increases in the odds of overweight or obesity. In females, only lack of positive affect was significantly associated with overweight or obesity, whereas the estimated associations of all other measures of depression on overweight or obesity were positive in males.

Conclusions

These findings provide evidence that depression is associated with overweight or obesity among adolescents in China, especially among males.
Comparison of the contributions of female and male authors to medical research in 2000 and 2015: a cross-sectional study
Authors: Gayet-Ageron Angele , Poncet Antoine , Perneger Thomas
Published: February 2019

Objectives

The proportion of women engaged in clinical research has increased over time. However, it is unclear if women and men contribute to the same extent during the conduct of research and, if so, if they are equally rewarded by a strategic first or last author position. We aim to describe the prevalence of women authors of original articles published 15 years apart and to compare the research contributions and author positions according to gender.

Design

Repeated cross-sectional study.

Setting

Published original articles.

Participants

1910 authors of 223 original articles published in theAnnals of Internal Medicinein 2000 and 2015.

Primary and secondary outcomes measures

Self-reported contributions to 10 aspects of the article (primary) and author position on the byline.

Results

The proportion of women authors increased from 32% (n=243) to 41% (n=469) between 2000 and 2015 (p<0.0001). In 2000, women authors were less frequently involved than men in the conception and design (134 (55%) vs 323 (61%); p=0.0256), critical revision (171 (70%) vs 426 (81%); p=0.0009), final approval (196 (81%) vs 453 (86%); p=0.0381) and obtaining of funding (39 (16%) vs 114 (22%); p=0.0245). Women were more frequently involved than men in administration and logistics (85 (35%) vs 137 (26%); p=0.0188) and data collection (121 (50%) vs 242 (46%); p=0.0532), but they were similarly involved in the analysis and interpretation of data, drafting of the manuscript, provision of materials/patients and statistical expertise. Women were less often last authors than men (22 (9%) vs 82 (16%); p=0.0102). These gender differences persisted in 2015.

Conclusions

The representation of women among authors of medical articles increased notably between 2000 and 2015, but still remained below 50%. Women’s roles differed from those of men with no change over time.
SALMANTICOR study. Rationale and design of a population-based study to identify structural heart disease abnormalities: a spatial and machine learning analysis
Authors: Melero-Alegria Jose Ignacio , Cascon Manuel , Romero Alfonso , Vara Pedro Pablo , Barreiro-Perez Manuel , Vicente-Palacios Victor , Perez-Escanilla Fernando , Hernandez-Hernandez Jesus , Garde Beatriz , Cascon Sara , Martin-Garcia Ana , Diaz-Pelaez Elena , de Dios Jose Maria , Uribarri Aitor , Jimenez-Candil Javier , Cruz-Gonzalez Ignacio , Blazquez Baltasara , Hernandez Jose Manuel , Sanchez-Pablo Clara , Santolino Inmaculada , Ledesma Maria Concepcion , Muriel Paz , Dorado-Diaz P Ignacio , Sanchez Pedro L
Published: February 2019

Introduction

This study aims to obtain data on the prevalence and incidence of structural heart disease in a population setting and, to analyse and present those data on the application of spatial and machine learning methods that, although known to geography and statistics, need to become used for healthcare research and for political commitment to obtain resources and support effective public health programme implementation.

Methods and analysis

We will perform a cross-sectional survey of randomly selected residents of Salamanca (Spain). 2400 individuals stratified by age and sex and by place of residence (rural and urban) will be studied. The variables to analyse will be obtained from the clinical history, different surveys including social status, Mediterranean diet, functional capacity, ECG, echocardiogram, VASERA and biochemical as well as genetic analysis.

Ethics and dissemination

The study has been approved by the ethical committee of the healthcare community. All study participants will sign an informed consent for participation in the study. The results of this study will allow the understanding of the relationship between the different influencing factors and their relative importance weights in the development of structural heart disease. For the first time, a detailed cardiovascular map showing the spatial distribution and a predictive machine learning system of different structural heart diseases and associated risk factors will be created and will be used as a regional policy to establish effective public health programmes to fight heart disease. At least 10 publications in the first-quartile scientific journals are planned.

Trial registration number

NCT03429452.
Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study
Authors: Liao Min-Tser , Chien Wu-Chien , Wang Jen-Chun , Chung Chi-Hsiang , Chu Shi-Jye , Tsai Shih-Hung
Published: February 2019

Objective

The aim of this study was to explore whether patients with Sjögren’s syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan.

Design

A nationwide population-based retrospective cohort study.

Setting

Data were extracted from Taiwan’s National Health Insurance Research Database (NHIRD).

Methodology

Medical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression.

Results

Overall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test <0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08%vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001).

Conclusion

Patients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.
Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre
Authors: Brooks John Alexander , McCudden Christopher , Breiner Ari , Bourque Pierre R
Published: February 2019

Objective

We set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).

Methods

We reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have ‘true’ ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described.

Results

The presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. ‘True’ ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with ‘pseudo’ ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001).

Conclusions

Elevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.
Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study
Authors: Burgon Clare , Darby Janet , Pollock Kristian , van der Wardt Veronika , Peach Tamsin , Beck Lyndsay , Logan Pip , Harwood Rowan H
Published: February 2019

Objective

To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.

Design

This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.

Setting

Community-based falls and memory assessment services in the East Midlands, UK.

Participants

Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).

Results

Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.

Conclusions

Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports
Authors: Milani Richard V , Wilt Jonathan K , Entwisle Jonathan , Hand Jonathan , Cazabon Pedro , Bohan Jefferson G
Published: February 2019

Importance

Antibiotic resistance is a global health issue. Up to 50% of antibiotics are inappropriately prescribed, the majority of which are for acute respiratory tract infections (ARTI).

Objective

To evaluate the impact of unblinded normative comparison on rates of inappropriate antibiotic prescribing for ARTI.

Design

Non-randomised, controlled interventional trial over 1 year followed by an open intervention in the second year.

Setting

Primary care providers in a large regional healthcare system.

Participants

The test group consisted of 30 primary care providers in one geographical region; controls consisted of 162 primary care providers located in four other geographical regions.

Intervention

The intervention consisted of provider and patient education and provider feedback via biweekly, unblinded normative comparison highlighting inappropriate antibiotic prescribing for ARTI. The intervention was applied to both groups during the second year.

Main outcomes and measures

Rate of inappropriate antibiotic prescription for ARTI.

Results

Baseline inappropriate antibiotic prescribing for ARTI was 60%. After 1 year, the test group rate of inappropriate antibiotic prescribing decreased 40%, from 51.9% to 31.0% (p<0.0001), whereas controls decreased 7% (61.3% to 57.0%, p<0.0001). In year 2, the test group decreased an additional 47% to an overall prescribing rate of 16.3%, and the control group decreased 40% to a prescribing rate of 34.5% after implementation of the same intervention.

Conclusions and relevance

Provider and patient education followed by regular feedback to provider via normative comparison to their local peers through unblinded provider reports, lead to reductions in the rate of inappropriate antibiotic prescribing for ARTI and overall antibiotic prescribing rates.
MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
Authors: Bhuva Anish N , Feuchter Patricia , Hawkins Angela , Cash Lizette , Boubertakh Redha , Evanson Jane , Schilling Richard , Lowe Martin , Moon James C , Manisty Charlotte H
Published: February 2019

Background

Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.

Aim

To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).

Methods

Patients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.

Results

215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.

Conclusion

Implementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.
Sex and intimacy in people with severe asthma: a qualitative study
Authors: Holmes Leanne Jo , Yorke Janelle A , Dutton Caroline , Fowler Stephen J , Ryan Dorothy
Published: February 2019

Introduction

People with severe asthma experience unpredictable daily symptoms requiring an intense treatment regimen impacting on health-related quality of life (QoL). Sexuality contributes to this, yet there is a dearth of research exploring intimacy in people with severe asthma. We aimed to explore the patient’s perception of the impact of severe asthma on intimacy, establish their information needs and their perceived role of the healthcare practitioner.

Methods

We have performed a qualitative study guided by Interpretive Phenomenological Analysis. We interviewed patients diagnosed with severe asthma recruited from a dedicated clinic using purposive sampling. Interviews were audio recorded and transcribed verbatim. Using thematic analysis, the data were analysed for emergent themes.

Results

The nine interviews provided unique and detailed insights into their perspectives on how living with severe asthma impinges on sexual intimacy. Four superordinate themes emerged: (1) ‘Physical intimacy’: including disclosure of physical limitations of severe asthma on intimacy; (2) ‘Emotional intimacy’: the cyclical impact of the often-negative emotional struggle of living with severe asthma on relationships; (3) ‘The role of the healthcare professional’: a perceived failure of healthcare professionals (HCPs) to tackle sexual intimacy in consultations and (4) ‘Image of self’: the reported struggle to deal with negative body image and confusion regarding changing relationship roles.

Discussion

This study is the first to explore the impact of severe asthma on intimacy. We suggest an emphasis on education to raise awareness and help HCPs to address this sensitive topic in this cohort and adopt positive strategies to help improve QoL.
The Long and Short of IT: intestinal failure-associated liver disease (IFALD) in adults—recommendations for early diagnosis and intestinal transplantation
Authors: Woodward Jeremy Mark , Massey Dunecan , Sharkey Lisa
Published: February 2019

Intestinal failure-associated liver disease (IFALD) often presents in adults unexpectedly with advanced disease. Non-invasive tests can be falsely reassuring. Patients with ‘ultrashort’ intestine (<20 cm) ending in a stoma are at particular risk of developing IFALD, which may occur rapidly. Recent experience and studies suggest that IFALD can be reversed by isolated intestine transplant occurring before the development of high grade fibrosis or cirrhosis. Post-transplant survival is superior for isolated intestinal grafts compared with liver containing intestinal grafts; waiting time and waiting list mortality is higher for a combined graft, and donor liver supply is limited. Therefore, the aim of clinicians treating patients with intestinal failure should be to identify IFALD early and refer to an intestinal transplant centre while isolated intestine transplantation can be contemplated and before the liver disease has progressed to a stage requiring consideration of combined liver and intestinal transplantation.
Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial
Authors: Ngu Wee Sing , Bevan Roisin , Tsiamoulos Zacharias P , Bassett Paul , Hoare Zoë , Rutter Matthew D , Clifford Gayle , Totton Nicola , Lee Thomas J , Ramadas Arvind , Silcock John G , Painter John , Neilson Laura J , Saunders Brian P , Rees Colin J
Published: February 2019

Objective

Low adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC).

Design

Patients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured.

Results

1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events.

Conclusion

EV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection.

Trial registration number

NCT02552017, Results; ISRCTN11821044, Results.
Multiple risk exposures for reading achievement in childhood and adolescence
Authors: Taylor Catherine Louise , Zubrick Stephen R , Christensen Daniel
Published: February 2019

Background

Literacy is championed as a pathway out of poverty, yet it is vulnerable to the risk circumstances it seeks to mitigate. This study explored the developmental circumstances that gave rise to stark inequalities in reading achievement in Australian children across 6 years of school.

Methods

We used data fromGrowing up in Australia: the Longitudinal Study of Australian Children linked to Australia’s National Assessment Program-Literacy and Numeracy across school years 3, 5, 7 and 9. Latent class analysis and growth curve modelling (n=4983) were used to identify risk profiles for reading achievement for children (ages 8.2–15.2).

Results

Four distinct profiles were identified: developmentally enabled profile (62% of children); sociodemographic risk profile (25% of children); child development risk profile (11% of children); and sociodemographic and child development (double disadvantage) risk profile (2% of children). Children with a developmentally enabled profile achieved the expected rate of growth of 1.0 year per year of school across years 3, 5, 7 and 9. By comparison, children with sociodemographic and/or child development risk profiles started behind their developmentally enabled peers, and lost ground over time.

Discussion

Across 6 years of school, multiple risk-exposed children lagged behind low risk-exposed children in the order of years of lost gains in reading achievement. The results point to the complex contexts of educational disadvantage and the need for cross-cutting social, health and education policies and coordinated multiagency intervention efforts to break the cycle of educational disadvantage.
WP1-8 Radiographic markers of disturbances in CSF dynamics: correlating imaging with 24-hour ICP monitoring
Authors: Asif H , Craven C , Thorne L , Watkins L , Toma A
Published: February 2019

Objectives

Disorders with chronically elevated ICP have salient imaging findings associated with the sella turcica and optic nerves. We aim to quantify the degree of correlation between imaging features and ICP.

Design

Prospective case-cohort study.

Subjects

One-hundred and twenty-six patients (35M:91F) underwent ICPM with recent MR imaging.

Methods

T1-saggital views for sella volume, optic nerve vertical tortuosity, then T2-axial views for optic nerve sheath distension were blindly reviewed against respective median ICP and pulse amplitudes (PA). Imaging was triple reviewed for discordant values.

Results

The mean ICP of four sella morphologies (full/flat/concave/empty) were 1.2, 4.8, 8.4 and 16.7 mmHg respectively (p<0.01). AUROC for sella morphology predicting ICP was 0.81. This measurement was able to detect minimum ICP of 5.3 mmHg with 73.0% sensitivity and specificity, 73.0% PPV and 69.8% NPV. The mean PA values were 4.0, 5.2, 6.1 and 9.6 mmHg respectively (p<0.01). AUROC for sella morphology predicting PA was 0.78. This measurement was able to detect minimum PA of 5.47 mmHg with 76.3% sensitivity, 79.5% specificity, 63.5% PPV and 81.0% NPV. Mean PA values for vertical tortuosity (nil/uni/bi) were 5.2, 7.1 and 7.0 mmHg respectively (p<0.05). Mean ICP values for rail tracking (nil/uni/bi) were 4.5, 7.5 and 15.7 mmHg respectively (p<0.01). Mean PA values were 5.2, 5.8 and 8.0 mmHg respectively (p<0.0001).

Conclusions

Combined radiological features of ICP are promising non-invasive markers for raised ICP.
P25 Hydrogel systems to enhance the delivery of cell therapy for traumatic spinal cord injury
Authors: Bartlett RD , Phillips JB , Choi D
Published: February 2019

Objectives

Cell therapies are an emerging therapeutic approach for spinal cord injury. We assessed the survival and phenotype of olfactory ensheathing cells (OECs) in hydrogel delivery systems suitable for clinical use.

Design

Laboratory study.

Methods

Cell survival in different formulations of collagen and fibrin hydrogels was assessed using Syto 9 and propidium iodide. The proportion of cells staining positive for a key repair marker (p75NTR) was also quantified using immunocytochemistry and fluorescence microscopy.

Results

There were significant differences in OEC survival between the various collagen and fibrin hydrogel formulations tested (p<0.001 one-way ANOVA, n=17). 10% v/v fibrin conferred the best cell survival with 85% of OECs remaining alive. Incorporating OECs into collagen hydrogels promoted the highest proportion of p75NTR immunopositive cells (78%) and this was significantly higher than both fibrin hydrogels and traditional monolayer culture (53% and 20%, respectively, p<0.0001 one-way ANOVA, n=24).

Conclusions

Collagen and fibrin hydrogels both have the potential to enhance the delivery, survival and retention of transplanted OECs for spinal cord repair. Both materials are clinically scalable, promote favourable OEC survival and have the potential to increase the proportion of cells expressing a key repair marker (p75NTR). Optimised hydrogel delivery systems may provide a valuable approach to improve the delivery of OECs for spinal cord repair in the future.