bluuebunny/crossref_metadata_2025 huggingface dataset:
Twenty-year outcomes in patients with newly diagnosed glaucoma: mortality and visual function
Authors: King Christopher , Sherwin Justin C , Ratnarajan Gokulan , Salmon John F
Published: March 2018

Background/aims

To determine the mortality within 20 years of diagnosis of chronic open-angle glaucoma (COAG) and visual acuity and visual field progression of a cohort followed for 20 years.

Methods

Twenty years following the diagnosis of COAG in 68 of 436 (16%) patients seen in a glaucoma case-finding clinic, visual and mortality outcomes were audited from medical records. Causes of death were obtained from general practitioner records and death certificates. Probability of death was calculated using a Kaplan-Meier survival curve. The visual field of each eye of survivors was graded using a nine-stage severity scale. Visual outcome was analysed at the 20-year follow-up visit.

Results

From 68, 14 (21%) were lost to follow-up. In the remaining 54, 20 (37%) were alive 20 years after diagnosis. Of 63% who died, mean age of death was 84 years, most commonly due to vascular disease. Mean age at presentation of those who died was 73.7 years versus 63.2 years for survivors (P=0.001). The median time to death was 16 years. On visual field analysis, nearly half (48.9%) of eyes did not deteriorate, but 28.3% eyes deteriorated by more than two stages. Those who died had worse final visual acuity than survivors (P<0.001). Three who died were registered severely visually impaired mainly from macular disease, but no survivors were registered (P<0.001).

Conclusion

In this cohort, approximately two-thirds of patients with glaucoma died within 20 years of diagnosis. In most older patients with glaucoma, the overall goal of preventing visual handicap and blindness is achievable 20 years after diagnosis.
A new model of exercise referral scheme in primary care: is the effect on adherence to physical activity sustainable in the long term? A 15-month randomised controlled trial
Authors: Martín-Borràs Carme , Giné-Garriga Maria , Puig-Ribera Anna , Martín Carlos , Solà Mercè , Cuesta-Vargas Antonio I
Published: March 2018

Introduction

Studies had not yet overcome the most relevant barriers to physical activity (PA) adherence. An exercise referral scheme (ERS) with mechanisms to promote social support might enhance adherence to PA in the long term.

Setting

A randomised controlled trial in 10 primary care centres in Spain.

Objective

To assess the effectiveness of a primary care-based ERS linked to municipal resources and enhancing social support and social participation in establishing adherence to PA among adults over a 15-month period.

Participants

422 insufficiently active participants suffering from at least one chronic condition were included. 220 patients (69.5 (8.4) years; 136 women) were randomly allocated to the intervention group (IG) and 202 (68.2 (8.9) years; 121 women) to the control group (CG).

Interventions

The IG went through a 12-week standardised ERS linked to community resources and with inclusion of mechanisms to enhance social support. The CG received usual care from their primary care practice.

Outcomes

The main outcome measure was self-report PA with the International Physical Activity Questionnaire and secondary outcomes included stages of change and social support to PA practice.

Data collection

Participant-level data were collected via questionnaires at baseline, and at months 3, 9 and 15.

Blinding

The study statistician and research assessors were blinded to group allocation.

Results

Compared with usual care, follow-up data at month 15 for the ERS group showed a significant increase of self-reported PA (IG: 1373±1845 metabolic equivalents (MET) min/week, n=195; CG: 919±1454 MET min/week, n=144; P=0.009). Higher adherence (in terms of a more active stage of change) was associated with higher PA level at baseline and with social support.

Conclusions

Prescription from ordinary primary care centres staff yielded adherence to PA practice in the long term. An innovative ERS linked to community resources and enhancing social support had shown to be sustainable in the long term.

Trial registration number

NCT00714831; Results.
Economic burden of cirrhosis in Catalonia: a population-based analysis
Authors: Miquel Mireia , Clèries Montserrat , Vergara Mercedes , Vela Emili
Published: March 2018

Background

Cirrhosis is a chronic disease with high morbidity and mortality. Few studies have evaluated healthcare resource use in patients with cirrhosis.

Objective

We aimed to describe the point prevalence of cirrhosis on 31 December 2012 and the population-level distribution of healthcare resource use and expenditures in a non-selected population of patients with cirrhosis, stratified by whether their disease was compensated or decompensated, and by comorbidity burden.

Methods

This population study included all known patients aged >18 years with cirrhosis (according to International Classification of Diseases, ninth revision) in Catalonia, Spain, on 31 December 2012. We evaluated healthcare resource use and expenditure during 2013, taking into account the presence of decompensation before or during 2012.

Results

We documented 34 740 patients diagnosed with cirrhosis (58.7% men; mean age 61.8±14 years), yielding a point prevalence of 460 per 100 000 inhabitants on 31 December 2012. Annual mortality was 9.1%. During 2013, healthcare expenditures on patients with cirrhosis totalled €142.1 million (€4234 per patient), representing 1.8% of the total 2013 healthcare budget of Catalonia. Hospitalisation costs accounted for 35.1% of the total expenditure and outpatient care accounted for 22.4%. MultivariateMultivariate logistic regression identified morbidity burden, HIV infection, hospitalisation and emergency room visits during 2012 as independent predictors of expenditure above the 85th centile (area under the receiver operating curve, 0.88 (95% CI 0.883 to 0.893, P<0.001)).

Conclusions

Cirrhosis accounts for a high proportion of healthcare resource usage and expenditures; hospitalisation accounted for the highest expenditures.
An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors
Authors: Gho Johannes M I H , Schmidt Amand F , Pasea Laura , Koudstaal Stefan , Pujades-Rodriguez Mar , Denaxas Spiros , Shah Anoop D , Patel Riyaz S , Gale Chris P , Hoes Arno W , Cleland John G , Hemingway Harry , Asselbergs Folkert W
Published: March 2018

Objectives

To investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).

Methods

Data were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.

Results

Of the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.

Conclusion

In England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.
Prevalence of xenobiotic substances in first-trimester blood samples from Danish pregnant women: a cross-sectional study
Authors: Aagaard Sissel Kramer , Larsen Agnete , Andreasen Mette Findal , Lesnikova Iana , Telving Rasmus , Vestergaard Anna Louise , Tørring Niels , Uldbjerg Niels , Bor Pinar
Published: March 2018

Objective

The aim of this study was to investigate the prevalence of xenobiotic substances, such as caffeine, nicotine and illicit drugs (eg, cannabis and cocaine), in blood samples from first-trimester Danish pregnant women unaware of the screening.

Design

A cross-sectional study examined 436 anonymised residual blood samples obtained during 2014 as part of the nationwide prenatal first-trimester screening programme. The samples were analysed by ultra performance liquid chromatography with high-resolution time-of-flight mass spectrometry.

Setting

An antenatal clinic in a Danish city with 62 000 inhabitants, where >95% of pregnant women joined the screening programme.

Primary and secondary outcome measures

The prevalence and patterns of caffeine, nicotine, medication and illicit drug intake during the first trimester of pregnancy.

Results

The prevalence of prescription and over-the-counter drug detection was 17.9%, including acetaminophen (8.9%) and antidepressants (3.0%), of which citalopram (0.9%) was the most frequent. The prevalence of illegal drugs, indicators of smoking (nicotine/cotinine) and caffeine was 0.9%, 9.9%, and 76.4%, respectively. Only 17.4% of women had no substance identified in their sample.

Conclusions

This study emphasises the need for further translational studies investigating lifestyle habits during pregnancy, as well as the underlying molecular mechanisms through which xenobiotic substances may affect placental function and fetal development.
Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints
Authors: Ilangkovan Nivethitha , Mogensen Christian Backer , Mickley Hans , Lassen Annmarie Touborg , Lambrechtsen Jess , Sand Niels Peter Ronnow , Albiniussen Rasmus , Byg Jørgen , Hald Flemming , Grønhøj Mette Hjortdal , Diederichsen Axel
Published: March 2018

Objectives

To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom.

Design

A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up.

Setting

Emergency and cardiology departments in the Region of Southern Denmark.

Subjects

In total, 229 patients with NSCP were compared with 722 patients from a background comparator population.

Main outcomes measures

Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact.

Results

There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death.

Conclusion

The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.

Trial registration number

NCT02422316; Pre-results.
Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems
Authors: Eshoj Henrik , Ingwersen Kim Gordon , Larsen Camilla Marie , Kjaer Birgitte Hougs , Juul-Kristensen Birgit
Published: March 2018

Objective

First, to investigate the intertester reliability of clinical shoulder instability and laxity tests, and second, to describe the mutual dependency of each test evaluated by each tester for identifying self-reported shoulder instability and laxity.

Methods

A standardised protocol for conducting reliability studies was used to test the intertester reliability of the six clinical shoulder instability and laxity tests: apprehension, relocation, surprise, load-and-shift, sulcus sign and Gagey. Cohen’s kappa (κ) with 95% CIs besides prevalence-adjusted and bias-adjusted kappa (PABAK), accounting for insufficient prevalence and bias, were computed to establish the intertester reliability and mutual dependency.

Results

Forty individuals (13 with self-reported shoulder instability and laxity-related shoulder problems and 27 normal shoulder individuals) aged 18–60 were included. Fair (relocation), moderate (load-and-shift, sulcus sign) and substantial (apprehension, surprise, Gagey) intertester reliability were observed across tests (κ 0.39–0.73; 95% CI 0.00 to 1.00). PABAK improved reliability across tests, resulting in substantial to almost perfect intertester reliability for the apprehension, surprise, load-and-shift and Gagey tests (κ 0.65–0.90). Mutual dependencies between each test and self-reported shoulder problem showed apprehension, relocation and surprise to be the most often used tests to characterise self-reported shoulder instability and laxity conditions.

Conclusions

Four tests (apprehension, surprise, load-and-shift and Gagey) out of six were considered intertester reliable for clinical use, while relocation and sulcus sign tests need further standardisation before acceptable evidence. Furthermore, the validity of the tests for shoulder instability and laxity needs to be studied.
Prediabetes in pregnancy, can early intervention improve outcomes? A feasibility study for a parallel randomised clinical trial
Authors: Hughes Ruth C E , Rowan Janet , Williman Jonathan
Published: March 2018

Objective

Measurement of glycated haemoglobin (HbA1c) in early pregnancy is routine in New Zealand to identify women with diabetes and prediabetes. However, the benefit of early intervention in women with prediabetes is inconclusive. Our aim was to test the feasibility of a two-arm parallel randomised controlled trial of standard care versus early intervention in pregnancies complicated by prediabetes.

Setting

Two tertiary referral centres in New Zealand.

Participants

Women <14 weeks’ gestation and HbA1c ≥5.9%–6.4% (41–46 mmol/mol) measured at booking, without pre-existing diabetes.

Interventions

Randomisation was done by remote web-based allocation into one of two groups. Women in the early intervention group attended an antenatal diabetes clinic, commenced daily home blood glucose monitoring, and medication was prescribed if lifestyle measures failed to maintain target blood glucose levels. Controls received lifestyle education, continued standard care with their midwife and/or obstetrician, and were asked to perform a 75 g oral glucose tolerance test at 24 weeks’ gestation with a referral to clinic if this test was positive. Both groups received lifestyle questionnaires at recruitment and in late pregnancy.

Outcome measures

Recruitment rate, adherence to protocol and validation of potential primary outcomes.

Results

Recruitment rates were lower than expected, especially in Māori and Pacific women. Non-adherence to allocated treatment protocol was significant, 42% (95% CI 24% to 61%) in the early intervention group and 30% (95% CI 16% to 51%) in controls. Caesarean section and pre-eclampsia were signalled as potential primary outcomes, due to both the high observed incidence in the control group and ease of measurement.

Conclusions

For a future definitive trial, extending the gestation of eligibility and stepped-wedge cluster randomisation may overcome the identified feasibility issues. Consistent with published observational data, pre-eclampsia and emergency caesarean section could be included as primary outcome measures, both of which have a significant impact on maternal and neonatal morbidity and healthcare costs.

Trial registration number

ACTRN12615000904572; Pre-results.
Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study
Authors: Peng Yen-Chun , Lin Cheng-Li , Sung Fung-Chang
Published: March 2018

Objectives

To evaluate the risk of pyogenic liver abscess (PLA) in patients receiving endoscopic sphincterotomy (ES).

Setting

A population-based cohort study using data from Taiwans’ National Health Insurance Research Database was conducted. Patients aged 20 or older who had undergone an ES were considered as the ES cohort. The dates for the first hospitalisation of the patients receiving ES were defined as the index dates.

Participants

Patients in the ES and non-ES cohorts were selected by 1:1 matching ratio based on a propensity score. A total of 8174 sex-matched, age-matched and index year-matched (1:1) pairs of patients receiving ES and 8174 patients without ES served as controls. Cox proportional hazards regression was employed to calculate the HRs and 95% CIs for the association between PLA and ES.

Results

The overall incidence of PLA was significantly higher in the ES cohort than in the non-ES cohort (4.20 vs 0.94, respectively, per 1000 person-year) with the adjusted HR (aHR) 4.50 (95% CI 3.38 to 6.58) A stratified analysis during the follow-up years revealed that when the ES cohort was compared with the non-ES cohort, they displayed a higher risk of PLA during the first follow-up year (aHR 4.35, 95% CI 2.26 to 8.39) which continued significantly over the next 4–5 years of follow-up.

Conclusions

Patients receiving ES are associated with having a higher risk of PLA.
Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners’ views
Authors: Fowler Davis Sally , Piercy Hilary , Pearson Sarah , Thomas Ben , Kelly Shona
Published: March 2018

Objectives

To report general practitioners’ (GPs’) views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister’s Challenge Fund (second wave) for England which aimed to extend patient access to primary care.

Setting

Primary care in Sheffield, England.

Participants

Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city.

Results

Four core themes were derived: GPs’ receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload.

Conclusions

The variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.
Diagnostic study on an immunochromatographic rapid test for schistosomiasis: comparison between use on serum and on blood spot from fingerprick
Authors: Buonfrate Dora , Rodari Paola , Brunelli Daniele , Degani Monica , Ragusa Andrea , Tais Stefano , Todeschini Martina , Bisoffi Zeno
Published: March 2018

Background

An immunochromatographic rapid test (ICT; Schistosoma ICT IgG-IgM, LDBIO Diagnostics) demonstrated high sensitivity (96%) in the diagnosis ofSchistosoma mansoniandS. haematobium. To date, the test has been validated for use on serum only, but in the absence of lab equipment, blood drop from fingerprick could be a useful option. This method is acquiring more interest because of the high flow of migrants rapidly moving across Italy and other European countries.

Objective

The aim of this prospective study was to evaluate the use of ICT on whole blood obtained from fingerprick.

Setting

Centre for Tropical Diseases (CTD), Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.

Participants

The inclusion criteria were African migrants aged ≥18 years with epidemiological risk of infection. The exclusion criteria were refusal to participate in the study and impossibility of execution of one of the two study methods, for any reason. Seventy of the 72 eligible patients completed the study, 79% of whom were male.

Interventions

The ICT was performed twice for each included patient: one on blood drop (by the research nurses, in the ward) and one on serum (by staff of CTD lab). The primary outcome was the concordance between the two methods, assessed by Cohen’s kappa.

Results

Cohen’s kappa was 0.45 (95% CI 27.0 to 63.6), indicating moderate agreement between the ICT on serum and the ICT on blood drop. Assuming the results on serum as reference standard for diagnosis, the sensitivity and specificity of ICT on blood drop were 55% (95% CI 40 to 69) and 93% (95% CI 79 to 98), respectively.

Conclusions

The agreement between the two diagnostic methods is too low to support the alternative one. Implementation of the kit for using blood drop instead of the serum and/or further studies aimed to identify easy-to-use tests for schistosomiasis feasible outside referral centres for tropical diseases are needed.
Management of haemothoraces in blunt thoracic trauma: study protocol for a randomised controlled trial
Authors: Carver David A , Bressan Alexsander K , Schieman Colin , Grondin Sean C , Kirkpatrick Andrew W , Lall Rohan , McBeth Paul B , Dunham Michael B , Ball Chad G
Published: March 2018

Introduction

Haemothorax following blunt thoracic trauma is a common source of morbidity and mortality. The optimal management of moderate to large haemothoraces has yet to be defined. Observational data have suggested that expectant management may be an appropriate strategy in stable patients. This study aims to compare the outcomes of patients with haemothoraces following blunt thoracic trauma treated with either chest drainage or expectant management.

Methods and analysis

This is a single-centre, dual-arm randomised controlled trial. Patients presenting with a moderate to large sized haemothorax following blunt thoracic trauma will be assessed for eligibility. Eligible patients will then undergo an informed consent process followed by randomisation to either (1) chest drainage (tube thoracostomy) or (2) expectant management. These groups will be compared for the rate of additional thoracic interventions, major thoracic complications, length of stay and mortality.

Ethics and dissemination

This study has been approved by the institution’s research ethics board and registered withClinicalTrials.gov.All eligible participants will provide informed consent prior to randomisation. The results of this study may provide guidance in an area where there remains significant variation between clinicians. The results of this study will be published in peer-reviewed journals and presented at national and international conferences.

Trial registration number

NCT03050502.
Cushing’s sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan
Authors: Yumoto Tetsuya , Naito Hiromichi , Yorifuji Takashi , Maeyama Hiroki , Kosaki Yoshinori , Yamamoto Hirotsugu , Tsukahara Kohei , Osako Takaaki , Nakao Atsunori
Published: March 2018

Objective

We tested whether Cushing’s sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma.

Design

Retrospective cohort study using Japan Trauma Data Bank.

Setting

Emergency and critical care centres in secondary and tertiary hospitals in Japan.

Participants

Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed.

Primary outcome measures

Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model.

Results

In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7–10 and 11–15 years of age; however, no significant association was observed in a group of 2–6 years of age.

Conclusions

Cushing’s sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.
Impact and acceptability of self-consent procedures for the school-based human papillomavirus vaccine: a mixed-methods study protocol
Authors: Audrey Suzanne , Batista Ferrer Harriet , Ferrie Joanne , Evans Karen , Bell Michael , Yates Julie , Roderick Marion , MacLeod John , Hickman Matthew
Published: March 2018

Introduction

The human papillomavirus (HPV) vaccine, administered in early adolescence, can substantially reduce cervical cancer incidence and mortality. However, lack of written parental consent is a key reason why some young women do not receive the vaccine. The national legal framework allows girls to be vaccinated without parental consent provided they are deemed Gillick competent, but there is some reticence about vaccinating without written parental consent. Self-consent procedures are being implemented in Bristol and South Gloucestershire. This study will examine the implementation, acceptability and impact of these new procedures.

Methods and analysis

Statistical analyses of routine data from Public Health England and the Child Health Information System will test if there has been an increase in HPV vaccination uptake in two ways: (a) Is there an increase when comparing before and after the change in our intervention sites? and (b) Does the percentage change in our intervention sites differ from comparison sites (similar to our intervention sites in terms of initial HPV uptake, ethnicity and deprivation levels) in England where no such intervention took place and how? For the process evaluation, we will develop a logic model and use questionnaires, observations and audio-recorded interviews with young women, school nurses, school staff and parents to examine the context, implementation of self-consent and response to the new procedures.

Ethics and dissemination

The University of Bristol Faculty of Health Sciences Research Ethics Committee and the National Health Service Health Research Authority provided approvals for the study. We will produce a report with recommendations about self-consent procedures in conjunction with key stakeholders. At least two papers will be written for publication in peer-reviewed journals and for conference presentations. A summary of results will be shared with participating immunisation nurses, school staff, young people and parents as requested.

Trial registration number

ISRCTN49086105; Pre-results.
Identifying research priorities for patient safety in mental health: an international expert Delphi study
Authors: Dewa Lindsay H , Murray Kevin , Thibaut Bethan , Ramtale Sonny Christian , Adam Sheila , Darzi Ara , Archer Stephanie
Published: March 2018

Objective

Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health.

Design

Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements.

Setting and participants

Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included.

Main outcome measures

Agreement in research priorities on a five-point scale.

Results

Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important.

Conclusions

This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this.
Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study
Authors: Mudge Alison M , Douglas Carol , Sansome Xanthe , Tresillian Michael , Murray Stephen , Finnigan Simon , Blaber Cheryl Ruth
Published: March 2018

Objectives

People with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality.

Methods

Prospective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients. Data sources included medical record and structured questions for medical and nursing staff. High-risk was predefined as positive response to the surprise question (SQ) plus two or more SPICT indicators of general deterioration. Descriptive variables included demographics, frailty and functional measures, treating team, advance care planning documentation and hospital utilisation. Primary outcome for prognostic performance was 12-month mortality.

Results

We identified 540 eligible inpatients on the study day and 513 had complete data (mean age 60, 54% male, 30% living alone, 19% elective admissions). Of these, 191 (37%) were high-risk; they were older, frailer, more dependent and had been in hospital longer than low-risk participants. Within 12 months, 92 participants (18%) died (72/191(38%) high-risk versus 20/322(6%) low-risk, P<0.001), providing sensitivity 78%, specificity 72%, positive predictive value 38% and negative predictive value 94%. SQ alone provided higher sensitivity, adding advanced disease indicators improved specificity.

Conclusions

The GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals.
‘Song of Life’: music therapy in terminally ill patients with cancer
Authors: Warth Marco , Kessler Jens , van Kampen Josien , Ditzen Beate , Bardenheuer Hubert J
Published: March 2018

Objectives

Music therapy (MT) holds a promising potential to meet emotional and existential needs in palliative care patients. The aim of the present pilot study was to assess the feasibility, acceptance and potential effectiveness of a novel MT intervention to improve life closure and spiritual well-being of terminally ill patients with cancer receiving palliative care.

Methods

The ‘Song of Life’ (SOL) intervention was provided on two consecutive sessions containing a biographical interview and a live performance of a song with high biographical relevance to the patient in a lullaby style. Pre-to-post intervention assessments comprised brief self-report measures on life closure, well-being, stress, worry and pain.

Results

13 out of 15 patients were able to complete the protocol as intended. The chosen songs were associated with a close person, an important place or event or with a religious belief. The results showed medium-sized improvements with regard to life closure, well-being, relaxation, worry and pain.

Conclusion

‘SOL’ proved to be a feasible and highly accepted intervention for patients approaching the end of their lives. Further consideration with regard to the procedures and outcomes is necessary before implementation of a randomised trial.
Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills
Authors: Clarke Samuel Owen , Julie Ian M , Yao Aubrey P , Bang Heejung , Barton Joseph D , Alsomali Sameerah M , Kiefer Matthew V , Al Khulaif Ali Hassan , Aljahany Muna , Venugopal Sandhya , Bair Aaron E
Published: March 2018

Introduction

In-hospital cardiac arrest (IHCA) affects 200 000 adults in the USA each year, and resuscitative efforts are often suboptimal. The objective of this study was to determine whether a programme of ‘mock codes’ improves group-level performance of IHCA skills. Our primary outcome of interest was change in cardiopulmonary resuscitation (CPR) fraction, and the secondary outcomes of interest were time to first dose of epinephrine and time to first defibrillation. We hypothesised that a sustained programme of mock codes would translate to greater than 10% improvement in each of these core metrics over the first 3 years of the programme.

Methods

We conducted mock codes in an urban teaching hospital between August 2012 and October 2015. Mock codes occurred on Telemetry and Medical/Surgical units on day and night shifts. Codes were managed by unit staff and members of the hospital’s ‘Code Blue’ team, and data were recorded by trained observers. Data were summarised using descriptive statistics, and repeated measures outcomes were calculated using a mixed effects model.

Results

Fifty-seven mock codes were included in the analysis: 42 on Medical/Surgical units and 15 on Telemetry units. CPR fraction increased by 2.9% per 6-month time interval on Telemetry units, and 1.3% per time interval on Medical/Surgical units. Neither time to first epinephrine dosing nor time to defibrillation changed significantly.

Conclusions

While we observed a significant improvement in CPR fraction over the course of this programme of mock codes, similar improvements were not observed for other key measures of cardiac arrest performance.
Simulation of childbirth improves clinical management capacity and self-confidence in medical students
Authors: Mannella Paolo , Antonelli Rachele , Montt-Guevara María Magdalena , Caretto Marta , Palla Giulia , Giannini Andrea , Pancetti Federica , Cuttano Armando , Simoncini Tommaso
Published: March 2018

Background The learning process of physiological mechanisms of childbirth and its management are important elements in the education of medical students. In this study, we verify how the use of a high-fidelity simulator of childbirth improves competence of students in this regard.

Methods A total of 132 medical students were recruited for the study in order to attend a physiological childbirth in a no-hospital environment after being assigned to two groups. The control group received only a normal cycle of lectures, while the simulation (SIM) group followed a specific training session on the simulator. Subsequently, both groups were assessed for their technical and non-technical skills in a simulated childbirth. Also, a self-assessment test regarding their self-confidence was administrated before and after simulation, and repeated after 8 weeks.

Results The SIM group showed better performance in all the domains with a better comprehension of the mechanisms of childbirth, managing and assistance of labour and delivery. In addition, compared to the control group, they presented a better self-related awareness and self-assurance regarding the possibility of facing a birth by themselves.

Conclusion The present study demonstrated that the use of a high-fidelity simulator for medical students allows a significant improvement in the acquisition of theoretical and technical expertise to assist a physiological birth.
Relationship between acute stress and clinical performance in medical students: a pilot simulation study
Authors: Russ Stephanie J , Morrison Ian , Bell Cheryl , Morse Jeremy Charles , Mackenzie Rhoda Katharine , Johnston Marie K
Published: March 2018

Background

Acute stress has been linked to impaired clinical performance in healthcare settings. However, few studies have measured experienced stress and performance simultaneously using robust measures in controlled experimental conditions, which limits the strength of their findings.

Aim

In the current study we examined the relationship between acute stress and clinical performance in second-year medical students undertaking a simulated ECG scenario. To explore this relationship in greater depth we manipulated two variables (clinical urgency and cognitive load), and also examined the impact of trait anxiety and task self-efficacy.

Methods

Second-year medical students were asked to conduct a 12-lead ECG on a simulated patient. Students were randomly assigned to one of four experimental conditions according to clinical urgency (high/low) and cognitive load (high/low), which were manipulated during a handover prior to the ECG. As part of the scenario they were asked to describe the ECG trace to a senior doctor over the phone and to conduct a drug calculation. They then received a performance debrief. Psychological stress and physiological stress were captured (via self-report and heart rate, respectively) and various aspects of performance were observed, including technical competence, quality of communication, work rate and compliance with patient safety checks. Trait anxiety and task self-efficacy were also captured via self-report.

Results

Fifty students participated. While there was little impact of experimental condition on stress or performance, there was a significant relationship between stress and performance for the group as a whole. Technical competence was poorer for those reporting higher levels of psychological stress prior to and following the procedure. Neither trait anxiety nor task self-efficacy mediated this relationship.

Conclusions

This study has provided evidence for a link between acute stress and impaired technical performance in medical students completing a simulated clinical scenario using real-time measures. The implications for patient safety and medical education are discussed.
First full annual cycle tracking of a declining aerial insectivorous bird, the Common Nighthawk (Chordeiles minor), identifies migration routes, nonbreeding habitat, and breeding site fidelity
Authors: Ng J.W. , Knight E.C. , Scarpignato A.L. , Harrison A.-L. , Bayne E.M. , Marra P.P.
Published: March 2018

Over one third of North American bird species are in decline, and for many species, we still lack fundamental biogeographic information such as migration routes and nonbreeding areas. Identifying causes of declines is limited because tracking many species throughout their annual cycle with high precision and accuracy is challenging. Common Nighthawks (Chordeiles minor (J.R. Forster, 1771)) have declined throughout much of their range and have yet to have their migratory and nonbreeding areas identified and characterized. We tracked Common Nighthawks by deploying a new 3.5 g Pinpoint GPS-Argos tag on adult males. Seven of 10 (70%) tags uploaded locations, providing the first data on migration, nonbreeding habitat, and annual site fidelity to breeding areas. Birds used similar loop migration routes and overwintered in Brazil’s Cerrado and Amazon regions. Nonbreeding season roosting home ranges were 148.22 ± 121 ha (mean ± SE) and included forest, grassland, and cropland. Breeding home-range fidelity was high; all tracked birds returned to within 1.27 ± 0.27 km of original capture locations. Our study is the first tracking of Common Nighthawks throughout their full annual cycle. Continued miniaturization of tracking technology, like the GPS-Argos transmitters used, is critical for identifying the causes of population declines of previously enigmatic migratory species.
The impact of acute salinity exposure and temperature on the survival, osmoregulation, and hematology of juvenile shortnose sturgeon (Acipenserbrevirostrum)
Authors: Downie Adam T. , Wallace Hannah , Taylor Samantha , Kieffer James D.
Published: March 2018

Juvenile shortnose sturgeon (Acipenser brevirostrum Lesueur, 1818) were exposed to seawater and freshwater for 24 h to evaluate the osmoregulatory capabilities over a seasonal temperature gradient (5, 10, 15, 20 °C). Additionally, juveniles were exposed to 5 °C seawater and freshwater over 72 h to evaluate survival and osmoregulatory capacity under cold water conditions. Osmoregulatory capability was evaluated using standard metrics: survival rate, mass loss, plasma chloride ion (Cl–) concentrations, osmolality, oxygen-carrying variables, and energy metabolites. Three mortalities occurred following 24 h exposure to 20 °C seawater (73% survival) and one mortality occurred within 72 h in 5 °C seawater (89% survival). Plasma Cl–concentrations and osmolality were elevated in seawater-exposed juveniles at every exposure time, regardless of temperature. The least mass was lost in juveniles exposed to 5 and 10 °C seawater, versus 15 and 20 °C seawater. Low mass loss is likely due to a lower metabolic rate and lower ventilation, which would slow the rate by which osmotic stress would occur under cold conditions.
Primary study of seroprevalence to virus pathogens in wild felids of South Primorie, Russia
Authors: Naidenko S.V. , Hernandez-Blanco J.A. , Pavlova E.V. , Erofeeva M.N. , Sorokin P.A. , Litvinov M.N. , Kotlyar A.K. , Sulikhan N.S. , Rozhnov V.V.
Published: March 2018

Seroprevalence to nine different virus pathogens was estimated for Russian big cats (Amur tiger (Panthera tigris altaica Temminck, 1844) and far-eastern leopard (Panthera pardus orientalis (Schiegel, 1857))) in Southern Primorie, Russia (n = 25), in 2008–2016. Serum samples from smaller cats (Eurasian lynx (Lynx lynx (Linnaeus, 1758)) and far-eastern wildcat (leopard cat) (Prionailurus bengalensis euptilurus (Elliot, 1871))) were also tested for these pathogens (n = 19) during the same period. Felids of Russian Southern Primorie showed seroprevalence to eight out of nine tested pathogens, including highly dangerous feline immunodeficiency virus, feline leukemia virus, and canine distemper virus. Antibodies to feline panleukopenia virus were found to be much more widespread in cats (45%) than antibodies to any other virus. They were detected in samples taken from tigers, leopards, and far-eastern wildcats but not lynxes. Antibodies to pseudorabies virus were detected only in Amur tiger (29%), whose main prey is the most common carrier of the virus (wild boar), unlike for the other studied cats’ species.
Contrasts in body size and growth suggest that high population density results in faster pace of life in Damaraland mole-rats (Fukomys damarensis)
Authors: Finn K.T. , Parker D.M. , Bennett N.C. , Zöttl M.
Published: March 2018

We studied the correlates of population density and body size, growth rates, litter size, and group size in Damaraland mole-rats (Fukomys damarensis (Ogilby, 1838)) at two study sites with contrasting population densities. Group size, litter size, and the probability of recapture were independent of study site. However, body size differed between the two study sites, suggesting that population density may affect life-history traits in social mole-rats. At the low-density site (0.13 groups/ha), individuals were significantly larger and subordinate males showed higher growth rates than at the high-density site (0.41 groups/ha), which may indicate that high population density in subterranean rodents enhances pace of life. The larger size of nonreproductive individuals at the low-density site could adapt individuals at lower population densities to larger dispersal distances.
First study on lipid dynamics during the female reproductive cycle ofPolybetes pythagoricus(Araneae: Sparassidae)
Authors: Romero S. , Laino A. , Arrighetti F. , Cunningham M. , Garcia C.F.
Published: March 2018

Spiders are valuable to humans, not only for their role in health but also as biologic pest controllers. In oviparous species, lipids are the main energy source for embryo development and the growth and survival of larvae. Using the spider Polybetes pythagoricus (Holmberg, 1875) as an experimental model, we studied the fluctuations in lipids and fatty acids occurring in tissues related to vitellogenesis. Different reproductive stages (previtellogenesis, early vitellogenesis, vitellogenesis, and postvitellogenesis) were determined histologically. Gonadosomatic and hepatosomatic indices were first used in spiders. The midgut diverticula proved to be the organ with the highest lipid concentration, with triacylglycerols as the major component. Phospholipids were the principal lipids transported. In vitellogenesis, a major accumulation of lipids occurred in the ovary, principally phosphatidylethanolamine (41%); it probably synthesized in the midgut diverticula before being released into the hemolymph for transport and accumulation in the ovary. Phosphatidylethanolamine is possibly involved in maintaining membrane fluidity and in the function of the electron transport chain. The principal fatty acids in the different organs were palmitic, stearic, oleic, and linoleic acids. During vitellogenesis, the ovaries become enriched in polyunsaturated fatty acids. The lipid patterns in the male midgut diverticula, muscle, and hemolymph were similar to those of the previtellogenic or postvitellogenic females.