bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study
Authors: Cabezas Carmen , Coma Ermengol , Mora-Fernandez Nuria , Li Xintong , Martinez-Marcos Montse , Fina Francesc , Fabregas Mireia , Hermosilla Eduardo , Jover Angel , Contel Juan Carlos , Lejardi Yolanda , Enfedaque Belen , Argimon Josep Maria , Medina-Peralta Manuel , Prieto-Alhambra Daniel
Published: August 2021

Objective

To determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers.

Design

Prospective cohort study.

Setting

Nursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020.

Participants

28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers.

Main outcome measures

Participants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use.

Results

Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis.

Conclusions

Vaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.
Identification and management of frail patients in English primary care: an analysis of the General Medical Services 2018/2019 contract dataset
Authors: Alharbi Khulud , Blakeman Thomas , van Marwijk Harm , Reeves David
Published: August 2021

Objectives

The aim of this study was to explore the extent of implementation of the General Medical Services 2018/2019 ‘frailty identification and management’ contract in general practitioner (GP) practices in England, and link implementation outcomes to a range of practice and Clinical Commissioning Group (CCG) factors.

Design

A cross-sectional study design using publicly available datasets relating to the year 2018 for all GP practices in England.

Settings

English general practices.

Data

The analysis was conducted across 6632 practices in 193 CCGs with 9 995 558 patients aged 65 years or older.

Outcomes

Frailty assessment rates, frailty coding rates and frailty prevalence rates, plus rates of medication reviews, falls assessments and enriched Summary Care Records (SCRs).

Analysis

Summary statistics were calculated and multilevel negative binomial regression analysis was used to investigate relationships of the six outcomes with explanatory factors.

Results

14.3% of people aged 65 years or older were assessed for frailty, with 35.4% of these—totalling 5% of the eligible population—coded moderately or severely frail. 59.2% received a medications review, but rates of falls assessments (3.7%) and enriched SCRs (21%) were low. However, percentages varied widely across practices and CCGs. Practice differences in contract implementation were most strongly accounted for by their grouping within CCGs, with weaker but still important associations with some practice and CCG factors, particularly healthcare demand-related factors of chronic caseload and (negatively) % of patients aged 65 years or older.

Conclusion

CCG appears the strongest determinant of practice engagement with the frailty contract, and fuller implementation may depend on greater engagement of CCGs themselves, particularly in commissioning suitable interventions. Practices understandably targeted frailty assessments at patients more likely to be found severely frail, resulting in probable underidentification of moderately frail individuals who might benefit most from early interventions. Frailty prevalence estimates based on the contract data may not reflect actual rates.
Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal
Authors: Usoro Agnes , Aiwonodagbon Benjamin , Strong Jonathan , Kivlehan Sean , Akodu Babatunde A , Olufadeji Ayobami
Published: August 2021

Introduction

Emergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.

Methods

Participants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.

Results

Three descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.

Conclusions

The participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.
Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol
Authors: Fitts Michelle S , Humphreys John , Dunbar Terry , Bourke Lisa , Mulholland Edward , Guthridge Steven , Zhao Yuejen , Jones Michael P , Boffa John , Ramjan Mark , Murakami-Gold Lorna , Tangey Annie , Comerford Clarissa , Schultz Rosalie , Campbell Narelle , Mathew Supriya , Liddle Zania , Russell Deborah , Wakerman John
Published: August 2021

Introduction

Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.

Methods and analysis

This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services.

Ethics and dissemination

The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
Evaluation of the initial implementation of a nationwide diabetic retinopathy screening programme in primary care: a multimethod study
Authors: Khou Vincent , Khan Muhammad Azaan , Jiang Ivy Wei , Katalinic Paula , Agar Ashish , Zangerl Barbara
Published: August 2021

Objectives

The Australian Government funded a nationwide diabetic retinopathy screening programme to improve visual outcomes for people with diabetes. This study examined the benefits and barriers of the programme, image interpretation pathways and assessed the characteristics of people who had their fundus photos graded by a telereading service which was available as a part of the programme.

Design

Multimethod: survey and retrospective review of referral forms.

Setting

Twenty-two primary healthcare facilities from urban, regional, rural and remote areas of Australia, and one telereading service operated by a referral-only eye clinic in metropolitan Sydney, Australia.

Participants

Twenty-seven primary healthcare workers out of 110 contacted completed a survey, and 145 patient referrals were reviewed.

Results

Manifest qualitative content analysis showed that primary healthcare workers reported that the benefits of the screening programme included improved patient outcomes and increased awareness and knowledge of diabetic retinopathy. Barriers related to staffing issues and limited referral pathways. Image grading was performed by a variety of primary healthcare workers, with one responder indicating the utilisation of a diabetic retinopathy reading service. Of the people with fundus photos graded by the reading service, 26.2% were reported to have diabetes. Overall, 12.3% of eyes were diagnosed with diabetic retinopathy. Photo quality was rated as excellent in 46.2% of photos. Referral to an optometrist for diabetic retinopathy was recommended in 4.1% of cases, and to an ophthalmologist in 6.9% of cases.

Conclusions

This nationwide diabetic retinopathy screening programme was perceived to increase access to diabetic retinopathy screening in regional, rural and remote areas of Australia. The telereading service has diagnosed diabetic retinopathy and other ocular pathologies in images it has received. Key barriers, such as access to ophthalmologists and optometrists, must be overcome to improve visual outcomes.
Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors’ professional behaviours and attitudes towards the regulator
Authors: Medisauskaite Asta , Potts Henry , Gishen Faye , Alexander Kirsty , Sarker Shah-Jalal , Griffin Ann
Published: August 2021

Objective

This paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.

Design

A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case.

Setting

Primary and secondary care settings across a broad geographical spread in England.

Participants

474 doctors.

Outcome measures

Attitudes towards the GMC and two professional behaviours in TPB dimensions.

Results

Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC’s disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors’ attitudes or intention to reflect or raise concerns.

Conclusions

The lack of change in doctors’ attitudes towards the GMC’s guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors’ trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors’ overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.
Soap versus sanitiser for preventing the transmission of acute respiratory infections in the community: a systematic review with meta-analysis and dose–response analysis
Authors: Hoffmann Tammy , Bakhit Mina , Krzyzaniak Natalia , Del Mar Chris , Scott Anna Mae , Glasziou Paul
Published: August 2021

Objective

To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events.

Design

Systematic review and meta-analysis.

Data sources

Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and trial registries were searched in April 2020.

Inclusion criteria

We included randomised controlled trials that compared a community-based hand hygiene intervention (soap and water, or sanitiser) with a control, or trials that compared sanitiser with soap and water, and measured outcomes of ARI, ILI or laboratory-confirmed influenza or related consequences.

Data extraction and analysis

Two review authors independently screened the titles and abstracts for inclusion and extracted data.

Results

Eighteen trials were included. When meta-analysed, three trials of soap and water versus control found a non-significant increase in ARI events (risk ratio (RR) 1.23, 95% CI 0.78 to 1.93); six trials of sanitiser versus control found a significant reduction in ARI events (RR 0.80, 95% CI 0.71 to 0.89). When hand hygiene dose was plotted against ARI relative risk, no clear dose–response relationship was observable. Four trials were head-to-head comparisons of sanitiser and soap and water but too heterogeneous to pool: two found a significantly greater reduction in the sanitiser group compared with the soap group and two found no significant difference between the intervention arms.

Conclusions

Adequately performed hand hygiene, with either soap or sanitiser, reduces the risk of ARI virus transmission; however, direct and indirect evidence suggest sanitiser might be more effective in practice.
How culture affects validity: understanding Japanese residents’ sense-making of evaluating clinical teachers
Authors: Kikukawa Makoto , Stalmeijer Renée E , Matsuguchi Takahiro , Oike Miyako , Sei Emura , Schuwirth Lambert W T , Scherpbier Albert J J A
Published: August 2021

Objectives

Traditionally, evaluation is considered a measurement process that can be performed independently of the cultural context. However, more recently the importance of considering raters’ sense-making, that is, the process by which raters assign meaning to their collective experiences, is being recognised. Thus far, the majority of the discussion on this topic has originated from Western perspectives. Little is known about the potential influence of an Asian culture on raters’ sense-making. This study explored residents’ sense-making associated with evaluating their clinical teachers within an Asian setting to better understand contextual dependency of validity.

Design

A qualitative study using constructivist grounded theory.

Setting

The Japanese Ministry of Health, Labour and Welfare has implemented a system to monitor the quality of clinical teaching within its 2-year postgraduate training programme. An evaluation instrument was developed specifically for the Japanese setting through which residents can evaluate their clinical teachers.

Participants

30 residents from 10 Japanese teaching hospitals with experience in evaluating their clinical teachers were sampled purposively and theoretically.

Methods

We conducted in-depth semistructured individual interviews. Sensitising concepts derived from Confucianism and principles of response process informed open, axial and selective coding.

Results

Two themes and four subthemes were constructed. Japanese residents emphasised the awareness of their relationship with their clinical teachers (1). This awareness was fuelled by their sense of hierarchy (1a) and being part of the collective society (1b). Residents described how the meaning of evaluation (2) was coloured by their perceived role as senior (2a) and their experienced responsibility for future generations (2b).

Conclusions

Japanese residents’ sense-making while evaluating their clinical teachers appears to be situated and affected by Japanese cultural values. These findings contribute to a better understanding of a culture’s influence on residents’ sense-making of evaluation instruments and the validity argument of evaluation.
Measuring quality of life in trials including patients on dialysis: how are transplants and mortality incorporated into the analysis? A systematic review protocol
Authors: Worboys Hannah M , Cooper Nicola J , Burton James O , Gray Laura J
Published: August 2021

Introduction

It is estimated that 25 000 people in the UK receive dialysis. Dialysis is an intrusive and time-consuming intervention that causes significant reductions in quality of life. When enrolled in a clinical trial, often some patients drop out of the study either because they die, receive a kidney transplant or are lost to follow-up for other reasons. It is unclear how these events are dealt with when analysing quality of life measures within clinical trials. This review will assess current practice for dealing with loss to follow-up in trials including patients on haemodialysis. The methods currently used will be analysed in terms of their adequacy and will form the basis of future work assessing the most appropriate methods to employ under these circumstances. The results of this review will feed into recommendations for future nephrology trials.

Methods and analysis

A systematic search of electronic databases including MEDLINE and the Cochrane Library will be conducted to find clinical trials enrolling patients on haemodialysis that measure quality of life using either the kidney disease quality of life (KDQoL) or the short form 36 health survey (SF-36) (or any variation of these two measures). Ongoing trials will be identified through a search of trial registers. Articles will be screened against inclusion/exclusion criteria and data will be extracted using a predetermined data extraction form. General information such as the title, location, trial design will be extracted along with more specific information on how the study dealt with patients that died or received a transplant before the end of the follow-up period. Two independent reviewers will perform screening and extraction. Disagreements will be resolved by discussion or by a third independent reviewer. Data synthesis will be performed as a narrative summary.

Ethics and dissemination

Ethics approval is not required. Dissemination will be by publication in a peer-reviewed journal.

PROSPERO registration number

CRD42020223869.
Ethnic variation in outcome of people hospitalised during the first COVID-19 epidemic wave in Wales (UK): an analysis of national surveillance data using Onomap, a name-based ethnicity classification tool
Authors: Thomas Daniel Rh , Orife Oghogho , Plimmer Amy , Williams Christopher , Karani George , Evans Meirion R , Longley Paul , Janiec Janusz , Saltus Roiyah , Shankar Ananda Giri
Published: August 2021

Objective

To identify ethnic differences in proportion positive for SARS-CoV-2, and proportion hospitalised, proportion admitted to intensive care and proportion died in hospital with COVID-19 during the first epidemic wave in Wales.

Design

Descriptive analysis of 76 503 SARS-CoV-2 tests carried out in Wales to 31 May 2020. Cohort study of 4046 individuals hospitalised with confirmed COVID-19 between 1 March and 31 May. In both analyses, ethnicity was assigned using a name-based classifier.

Setting

Wales (UK).

Primary and secondary outcomes

Admission to an intensive care unit following hospitalisation with a positive SARS-CoV-2 PCR test. Death within 28 days of a positive SARS-CoV-2 PCR test.

Results

Using a name-based ethnicity classifier, we found a higher proportion of black, Asian and ethnic minority people tested for SARS-CoV-2 by PCR tested positive, compared with those classified as white. Hospitalised black, Asian and minority ethnic cases were younger (median age 53 compared with 76 years; p<0.01) and more likely to be admitted to intensive care. Bangladeshi (adjusted OR (aOR): 9.80, 95% CI 1.21 to 79.40) and ‘white – other than British or Irish’ (aOR: 1.99, 95% CI 1.15 to 3.44) ethnic groups were most likely to be admitted to intensive care unit. In Wales, older age (aOR for over 70 years: 10.29, 95% CI 6.78 to 15.64) and male gender (aOR: 1.38, 95% CI 1.19 to 1.59), but not ethnicity, were associated with death in hospitalised patients.

Conclusions

This study adds to the growing evidence that ethnic minorities are disproportionately affected by COVID-19. During the first COVID-19 epidemic wave in Wales, although ethnic minority populations were less likely to be tested and less likely to be hospitalised, those that did attend hospital were younger and more likely to be admitted to intensive care. Primary, secondary and tertiary COVID-19 prevention should target ethnic minority communities in Wales.
Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis
Authors: Ke Jun , chen Yiwei , Wang Xiaoping , Wu Zhiyong , Chen Feng
Published: August 2021

Background

The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).

Methods

We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).

Results

The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.

Conclusions

TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.
Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D)
Authors: Paskins Zoe , Bullock Laurna , Crawford-Manning Fay , Cottrell Elizabeth , Fleming Jane , Leyland Sarah , Edwards John James , Clark Emma , Thomas Simon , Chapman Stephen Robert , Ryan Sarah , Lefroy J E , Gidlow Christopher J , Iglesias C , Protheroe Joanne , Horne Robert , O'Neill Terence W , Mallen Christian , Jinks Clare
Published: August 2021

Introduction

Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work.

Methods and analysis

The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial.

Ethics and dissemination

Ethical approval was obtained from North West—Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations.

Trial registration number

researchregistry5041.
Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China
Authors: Zhang Ya , Gu Shujun , Wang Cuicui , Liu Dong , Zhang Qiuyi , Yang Man , Zhou Zhengyuan , Zuo Hui
Published: August 2021

Objectives

Diabetes mellitus has been associated with stroke. However, the association between fasting blood glucose (FBG) and stroke risk in a general population remains not clear. The purpose of our study was to examine the FBG levels on subsequent stroke risk in a community-based cohort in China.

Design

Prospective cohort study, employing Cox proportional hazard model to analyse the association of FBG levels with stroke risk.

Setting

A community-based cohort study included adults participating in a baseline survey conducted in 2013 in Changshu, eastern China.

Participants

16 113 participants were recruited with a multistage sampling method, excluding participants with severe disability, severe cancer, severe psychiatric disturbance or previous stroke before enrolment.

Primary outcome measures

Stroke events.

Results

During a median follow-up of 5.5 years, 417 incident cases of stroke were identified. The adjusted HR for total and ischaemic stroke for participants in the fourth quartile of FBG compared with the first quartile was 1.44 (95% CI 1.07 to 1.94) and 1.57 (95% CI 1.11 to 2.21), respectively. FBG levels of ≥7.0 mmol/L were associated with an increased risk of stroke based on two clinical classifications (American Diabetes Association: 1.68 (1.24 to 2.27); WHO: 1.62 (1.21, 2.13)). In stratified analyses, risk associations existed in women (HR: 1.92, 95% CI 1.22 to 3.01) and postmenopausal women (HR: 1.68, 95% CI 1.06 to 2.68) for the fourth quartile versus the first. More importantly, the meta-analysis observed a positive association between FBG levels and stroke risk (pooled HR: 1.70, 95% CI 1.27 to 2.29; n=7)).

Conclusions

Higher FBG level was independently associated with an increased risk of stroke in Chinese adults, especially significant in women.
Treatment pathways in people with type 2 diabetes mellitus: a nationwide cohort study of new users of metformin monotherapy in New Zealand
Authors: Guo Joyce , Parkin Lianne , Zeng Jiaxu , Barson David , Horsburgh Simon
Published: August 2021

Objectives

The aims of this study were to describe the following: (1) the time to change of therapy in patients with type 2 diabetes who had initiated metformin monotherapy as first-line treatment and (2) the sequence in which subsequent therapeutic regimens were introduced.

Design

Cohort study.

Setting

National study based on linked data from the New Zealand Ministry of Health’s National Collections of health and pharmaceutical dispensing data.

Participants

People with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 (n=93 874).

Primary outcome measures

Cumulative incidence curves were plotted to show the time taken to move from one regimen to another, while sunburst plots were used to illustrate the sequence in which regimens were introduced.

Results

About 10% and 35% of cohort members had moved to a second regimen 1 year and 5 years, respectively, after initiating metformin monotherapy; the majority received a regimen recommended by New Zealand treatment guidelines (mostly metformin and a sulphonylurea). Of those who started a recommended second regimen, 37% and 67% had moved to a third regimen after 1 and 5 years, respectively; the corresponding proportions for those who started an ‘other’ (not listed as recommended) second regimen were 53% and 75%. Most of those who received a third regimen after a recommended second regimen were dispensed an ‘other’ third regimen. Of those who moved to a third regimen from an ‘other’ second regimen, similar proportions received recommended and ‘other’ third regimens.

Conclusions

Real-world type 2 diabetes treatment patterns in New Zealand are complex and not always consistent with guidelines.
Lay perspectives of the open-label placebo rationale: a qualitative study of participants in an experimental trial
Authors: Locher Cosima , Buergler Sarah , Frey Nascimento Antje , Kost Linda , Blease Charlotte , Gaab Jens
Published: August 2021

Objectives

To analyse participants’ concepts about the open-label placebo (OLP) effect; to explore their views about the discussion points that are applied in conventional OLP trials and to examine their experiences of taking part in an OLP trial.

Design

A qualitative study using thematic analysis of semistructured interviews that were nested within a randomised controlled trial investigating experimental OLP analgesia (registered at ClinicalTrials.gov:NCT02578420).

Participants

30 healthy adults who took part in the randomised controlled trial.

Results

Participants mostly conceptualised placebo as something that is inert and requires deception in order to be effective. Interviewees used a broad definition of placebos, going beyond a conventional notion of sugar pills. In contrast to the conventional OLP rationale, participants seldom emphasised classical conditioning as a mechanism of placebo effects, stressing a variety of other well-established components through which placebos might be therapeutic, whereas the conventional OLP disclosures state that ‘a positive attitude helps but is not necessary’, participants in our study applied other attitudes, such as ‘it’s worth a try’. When asked about their experiences during the trial, the majority emphasised that the concept of OLP was completely novel to them. Participants were rather sceptical about the efficacy of the intervention.

Conclusion

Integrating lay perspectives into the scientific rationale of OLP treatments might enhance the plausibility and credibility of the rationale in ethical treatments.

Trial registration number

NCT02578420.
Identifying non-traditional electronic datasets for population-level surveillance and prevention of cardiometabolic diseases: a scoping review protocol
Authors: Rebinsky Reid , Anderson Laura N , Morgenstern Jason D
Published: August 2021

Introduction

Cardiometabolic diseases, including cardiovascular disease, obesity and diabetes, are leading causes of death and disability worldwide. Modern advances in population-level disease surveillance are necessary and may inform novel opportunities for precision public health approaches to disease prevention. Electronic data sources, such as social media and consumer rewards points systems, have expanded dramatically in recent decades. These non-traditional datasets may enhance traditional clinical and public health datasets and inform cardiometabolic disease surveillance and population health interventions. However, the scope of non-traditional electronic datasets and their use for cardiometabolic disease surveillance and population health interventions has not been previously reviewed. The primary objective of this review is to describe the scope of non-traditional electronic datasets, and how they are being used for cardiometabolic disease surveillance and to inform interventions. The secondary objective is to describe the methods, such as machine learning and natural language processing, that have been applied to leverage these datasets.

Methods and analysis

We will conduct a scoping review following recommended methodology. Search terms will be based on the three central concepts of non-traditional electronic datasets, cardiometabolic diseases and population health. We will search EMBASE, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library peer-reviewed databases and will also conduct a grey literature search. Articles published from 2000 to present will be independently screened by two reviewers for inclusion at abstract and full-text stages, and conflicts will be resolved by a separate reviewer. We will report this data as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Ethics and dissemination

No ethics approval is required for this protocol and scoping review, as data will be used only from published studies with appropriate ethics approval. Results will be disseminated in a peer-reviewed publication.
Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study
Authors: Johnson Leigh , Holcombe Chris , O’Donoghue Joe M , Jeevan Ranjeet , Browne John , Fairbrother Patricia , MacKenzie Mairead , Gulliver-Clarke Carmel , White Paul , Mohiuddin Syed , Hollingworth William , Potter Shelley
Published: August 2021

Introduction

Breast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the long-term outcomes of different BR procedures is essential to support informed decision-making. As different techniques vary considerably in cost, policymakers also require high-quality cost-effectiveness evidence to inform care. The Brighter study aims to explore the long-term clinical and patient-reported outcomes (PROs) of implant-based and autologous BR and use health economic modelling to compare the long-term cost-effectiveness of different reconstructive techniques.

Methods and analysis

Women undergoing mastectomy and/or BR following a diagnosis of breast cancer between 1 January 2008 and 31 March 2009 will be identified from hospital episode statistics (HES). Surviving women will be contacted and invited to complete validated PRO measures including the BREAST-Q, EQ-5D-5L and ICECAP-A, or opt out of having their data included in the HES analysis. Long-term clinical outcomes will be explored using HES data. The primary outcome will be rates of revisional surgery between implant-based and autologous procedures. Secondary outcomes will include rates of secondary reconstruction and reconstruction failure. The long-term PROs of implant-based and autologous reconstruction will be compared using BREAST-Q, EQ-5D-5L and ICECAP-A scores. Multivariable regression will be used to examine the relationship between long-term outcomes, patient comorbidities, sociodemographic and treatment factors. A Markov model will be developed using HES and PRO data and published literature to compare the relative long-term cost-effectiveness of implant-based and autologous BR.

Ethics and dissemination

The Brighter study has been approved by the South-West -Central Bristol Research Ethics Committee (20/SW/0020), and the Confidentiality Advisory Group (20/CAG/0021). Results will be published in peer-reviewed journals and presented at national meetings. We will work with the professional associations, charities and patient groups to disseminate the results.
Practical prescribing
Authors: Brodie Martin J , Harrison Ian
Published: August 2021

This book is a practical manual for the prescriber rather than a text book. The first chapter usefully explains pharmacological terms which are used later in the book. This is followed by three sections concerned with choosing drugs. The first section gives a list of ‘best buys’ for common complaints, the second looks at treatment policies and the third gives basic pharmacological information to help in making choices. Side-effects and drug interactions are presented in the next two chapters in a readily accessible form. The final chapter, called ‘Cautions,’ has some useful information not readily found elsewhere including data on teratogenesis and shelf-life of formulations. It also suggests which drugs we should stop using, and discusses factors to consider before using a new drug.
Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm
Authors: Rasmussen Anders Mølgaard , Toft Mette Helene , Awada Hussein Nasser , Dirks Jesper , Brandsborg Birgitte , Rasmussen Line Kirkegaard , Kirkegaard Ellen , Hasfeldt-Hansen Dorthe , Larsen Thomas Egemose , Charalampidis Georgios , Mørk Emilie Louise Schjøtt , Rosager Chirstine Linaa , Salam Idress Ahmad , Rasmussen Bodil Steen , Jørgensen Marlene , Skjønnemand Martin , Lund Caterina Amanti , Schroder Save , Sørensen Johan Kløvgaard , Sølling Christoffer , Hansen Kristian Kraft , Rasmussen Christina Kirkegaard , Steen Nick Phaff , Nielsen Anne Staal , Geisler Anja , Køppen Kasper Storm , Pælestik Maria Bolther , Grøfte Thorbjørn , Meyhoff Christian Sylvest , Kroh Charlotte Loumann , Christensen Amalie Prien , Haugstvedt Aleksander Fjeld , Hansen Maria Aagaard , Nielsen Christian Viggo , Dybdal Bitten , Falcon Lars , Hägi-Pedersen Daniel , Jauho Kristian , Wolsted Henrik , Pedersen Christian Alves Kohler , Sommer Trine Nyboe , Kromberg Laurits Schou , Kristensen Danja Lykke , Svensson Camilla Kara , Nielsen Hans Fjeldsøe , Sørensen Martin Kryspin , Jacobsen Stig , Sundskard Martin , Brahe Nicole , Jakobsen Karina , Jensen Mette Skov , Odder Lillian , Selter Hansjörg , Mohr Tróndur Høgnason , Jensen Elin H , Jensen Pernille Pia , Skjold Christine , Aasvang Eske Kvanner
Published: August 2021

Background

Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.

Methods

This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.

Results

A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%–37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.

Conclusion

Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.

Trial registration number

RoPR ID 43191.
Design guidance for protection of geomembrane liners in landfill applications
Authors: Marcotte B.A. , Fleming I.R.
Published: August 2021

A new method of evaluating strains and predicting required protection layers that are placed over geomembranes is developed based on the combined effects of the clay strength and stiffness and the cushioning effect of a nonwoven protection layer. Plots giving the required geotextile protection for different maximum strains are presented for expected landfill pressures under 300 kPa for angular, 38 mm gravel placed above a geomembrane liner for both drained and undrained loading conditions of the clay. A similar plot is also given for tire-derived aggregate placed above the liner for pressures under 500 kPa for undrained loading conditions. All tests were conducted at room temperature. For all cases, nonwoven geosynthetic protection layers with mass per unit area (MUA) exceeding at least 1200 g/m2were required to limit long-term strains below current threshold levels. The MUA of the protection layer, for the particular aggregates and geomembranes tested, is dependent on the loading rate, water content relative to optimum, the silt content, and the activity of the clay below.
Nonassociative gauge fields
Authors: Loginov E. K.
Published: August 2021

In this paper, we study consequences of the assumption that the gauge group [Formula: see text] of the standard model is a nonassociative image of [Formula: see text]. Such an approach allows us to take a different look at the Higgs mechanism and obtain the value of the Weinberg angle in very good agreement with the experiment.
Electronic performance of GaN nanowires cathode under electric field
Authors: Huang Siyuan , Liu Lei , Lu Feifei
Published: August 2021

The built-in electric field of exponential doping can promote the concentration of the photogenerated carrier center to the top surface of the nanowire. The external electric field also can bend the motion trajectory of the emitted electrons toward the collecting side. These field-assisted methods promote the quantum efficiency. In this paper, the emission theory of a single GaN nanowire photocathode is studied for the first time. The effects of height and width of the nanowire, wavelength, intensity of electric field on quantum efficiency of uniformly doped or exponentially doped GaN nanowire photocathodes were explored. It shows that the top of the exponentially doped cathode has a higher quantum efficiency than uniformly doped cathode. With the absence of the field, quantum efficiency of a uniformly doped cathode reaches a maximum value of 55.29% when the width is 150 nm and the wavelength is 220 nm. The form of exponentially doped cathode can generate an internal field. With the internal field, a maximum value rises 56.73% when the height is 900 nm and the wavelength is 230 nm. The theoretical results can direct the preparation of this kind of photocathode.
Optical properties of silicene-dielectric interfaces from IR to far UV
Authors: Hou Yujun , Jiang Chun
Published: August 2021

Since the growth of single layer of Si has emerged, silicene became a potential candidate material to make up the disadvantage of graphene. In this paper, the complex surface conductivity is applied to characterize the properties of silicene and we investigate the optical characterization of silicene-dielectric interfaces from IR to far UV range. The silicene-Si and silicene-Ge interfaces along both parallel and perpendicular polarization directions of electromagnetic field with normal incidence are considered in this work. The optical properties of the silicene-dielectric systems proposed in this paper lay a foundation for the performance of complex silicene-based optoelectronic devices such as sensors, detectors, filters, UV absorbers and so on.