bluuebunny/crossref_metadata_2025 huggingface dataset:
Does time spent in the residential neighbourhood moderate the relationship between neighbourhood walkability and transport-related walking? a cross-sectional study from Toronto, Canada
Authors: Chum Antony , Atkinson Peter , O’Campo Patricia
Published: April 2019

Objectives

Studies have investigated the influence of neighbourhood walkability on residents’ walking behaviour, aiming to increase physical activity and reduce dependence on automobiles. Previous research, however, has not considered how the amount of time spent in the residential neighbourhood may modify this relationship. Our objective was to determine how time spent in the residential neighbourhood affects the relationship between neighbourhood walkability and walking for transport.

Design

Using a cross-sectional sample of 2411 adults, we analysed the association between walkability (an index combining land-use mix, dwelling density and street connectivity) and transport-related walking (controlling for the effects of gender, age, income, self-rated health and regular access to private transport) testing for interactions by time spent in the neighbourhood.

Primary outcome measure

Minutes spent walking for transport per week.

Setting

Toronto, Canada.

Participants

Participants were aged 25 to 65. The survey had a 72% response rate.

Results

After adjusting for potential confounders, the walkability index was weakly associated with walking (1 SD of walkability score is associated with 0.25 more minutes walking/week, p<0.01). Land-use mix was more strongly associated with walking than the walkability index. Time spent at the residential neighbourhood modified the relationship between land-use mix and transport-related walking in a dose-effect manner (p<0.01), those spending 5 hours on average at their residential neighbourhood have 0.2 min/day more walking for each additional land-use mix score and those spending 12 hours have 0.5 min/day more walking for each additional land-use mix score.

Conclusions

Our findings suggest that walkability is associated with increased walking time, but it is modified by time spent in the neighbourhood. Our study underscores the importance of testing ‘time spent in the neighbourhood’ as a modifier of environmental exposures in studies of environmental correlates of walking.
Qualitative descriptive study to explore nurses’ perceptions and experience on pain, agitation and delirium management in a community intensive care unit
Authors: Tsang Jennifer L Y , Ross Katie , Miller Franziska , Maximous Ramez , Yung Priscilla , Marshall Carl , Camargo Mercedes , Fleming Dimitra , Law Madelyn
Published: April 2019

Objectives

The purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients.

Design

A qualitative descriptive study.

Setting

This study took place in a community hospital ICU located in a medium size Canadian city.

Participants

Purposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated.

Methods

A total of five focus group sessions were held to collect data. There were one to three separate groups in each focus group session, with no more than seven participants in each group. There were 10 separate groups in total. A semistructured question guide was used. Thematic analysis method was adopted to analyse the data, and to search for emergent themes and patterns.

Results

Three main themes emerged: (1) the professional perspectives on patient wakefulness state, (2) the professional perspectives on PAD management of critically ill patients and (3) the factors impacting PAD management. Nurses have different opinions on the optimal level of patient sedation and felt that many factors, including environmental, healthcare teams, patients and family members, can influence PAD management. This potentially leads to inconsistent PAD management in critically ill patients. The nurses also believed that PAD management requires a multidisciplinary approach including healthcare teams and patients’ families.

Conclusions

Many external and internal factors contribute to the complexity of PAD management including the attitudes of nursing staff towards PAD. The themes emerged from this study suggested the need of a multifaceted and multidisciplinary quality improvement programme to optimise the management of PAD in the ICU.
Biomarkers of autonomic regulation for predicting psychological distress and functional recovery following road traffic injuries: protocol for a prospective cohort study
Authors: Pozzato Ilaria , Craig Ashley , Gopinath Bamini , Tran Yvonne , Dinh Michael , Gillett Mark , Cameron Ian
Published: April 2019

Introduction

Psychological distress is a prevalent condition often overlooked following a motor vehicle crash (MVC), particularly when injuries are not severe. The aim of this study is to examine whether biomarkers of autonomic regulation alone or in combination with other factors assessed shortly after MVC could predict risk of elevated psychological distress and poor functional recovery in the long term, and clarify links between mental and physical health consequences of traffic injury.

Methods and analysis

This is a controlled longitudinal cohort study, with follow-up occurring at 3, 6 and 12 months. Participants include up to 120 mild to moderately injured MVC survivors who consecutively present to the emergency departments of two hospitals in Sydney and who agree to participate, and a group of up to 120 non-MVC controls, recruited with matched demographic characteristics, for comparison. WHO International Classification of Functioning is used as the framework for study assessment. The primary outcomes are the development of psychological distress (depressive mood and anxiety, post-traumatic stress symptoms, driving phobia, adjustment disorder) and biomarkers of autonomic regulation. Secondary outcomes include indicators of physical health (presence of pain/fatigue, physical functioning) and functional recovery (quality of life, return to function, participation) as well as measures of emotional and cognitive functioning. For each outcome, risk will be described by the frequency of occurrence over the 12 months, and pathways determined via latent class mixture growth modelling. Regression models will be used to identify best predictors/biomarkers and to study associations between mental and physical health.

Ethics and dissemination

Ethical approvals were obtained from the Sydney Local Health District and the research sites Ethics Committees. Study findings will be disseminated to health professionals, related policy makers and the community through peer-reviewed journals, conference presentations and health forums.

Trial registration number

ACTRN12616001445460.
Management of acute musculoskeletal pain (excluding low back pain): protocol for a systematic review and network meta-analysis of randomised trials
Authors: Busse Jason W , Craigie Samantha , Sadeghirad Behnam , Couban Rachel , Hong Patrick , Oparin Yvgeniy , May Curtis , Lok Annie , Guyatt Gordon H
Published: April 2019

Introduction

Acute, non-low back-related musculoskeletal pain is common and associated with significant socioeconomic costs. No review has evaluated all interventional studies for acute musculoskeletal pain, which limits attempts to make inferences regarding the relative effectiveness of treatments.

Methods and analysis

We will conduct a systematic review of all randomised controlled trials evaluating therapies for acute musculoskeletal pain (excluding low back pain). We will identify eligible, English-language, trials by a systematic search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, Physiotherapy Evidence Database (PEDro) and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to February 2018. Eligible trials will: (1) enrol patients presenting with acute, non-low back-related musculoskeletal pain (duration of pain ≤4 weeks), and (2) randomise patients to alternative interventions or an intervention and a placebo/sham arm. Fractures will be considered ineligible, unless they are non-surgical and therapy is directed at pain relief. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible trials and extract information from eligible trials. We will use a modified Cochrane instrument to evaluate risk of bias. Disagreements will be resolved through discussion to achieve consensus. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence supporting treatment effects. When possible, we will conduct: (1) in direct comparisons, a random-effect meta-analysis to establish the effectiveness of therapeutic interventions on patient-important outcomes; and (2) multiple treatment comparison meta-analysis to assess the relative effects of treatments. We will use a priori hypotheses to explain heterogeneity between studies. We will use STATA V.14.2 for all analyses.

Ethics and dissemination

No research ethics approval is required for this systematic review, as no confidential patient data will be used. The results of this systematic review will be disseminated through publication in a peer-reviewed journal, conference presentations and will inform a clinical practice guideline.

PROSPERO registration number

CRD42018094412.
How to strengthen clinical research in Shenzhen, China: qualitative study
Authors: Ji Ping , Chu Hongling , Zhang Chao , Xiao Ping , Liu Min , Zhou Liping , Wang Haibo , Wang Yanfang , Wu Yangfeng
Published: April 2019

Objectives

To better understand the strengths and weaknesses, and to propose policy recommendations, regarding conducting high-quality clinical research in Shenzhen, China.

Design

A qualitative study conducted from August to November 2016 using a semistructured interview format involving both focus group interviews and individual interviews.

Setting

Shenzhen, China.

Participants

Stratified purposive and convenience sampling were used. Thirty individuals experienced in conducting and managing clinical research were selected from key stakeholder groups, comprising 11 from local hospitals, 14 from pharmaceutical/medical device companies and 5 from government agencies.

Methods

A semistructured interview guide was developed by the study group and used by experienced interviewers in focus group discussions and individual interviews. The interviewees were encouraged to share their opinions freely and discuss their own topics of interest during the interviews. Thematic analysis was used for analysis and all data were coded and extracted using NVivo V.11.0 software.

Results

Favourable driving factors for clinical research in Shenzhen identified by all stakeholders included the recent trend of increased governmental funding for clinical research, supportive governmental policies, wide recognition of the value of clinical research and high demands from local industry. The major challenges include a lack of technical infrastructure, weak human research subject protection and a lack of capable research resources.

Conclusions

Despite the established strengths, Shenzhen still needs to develop suitable technical platforms, human resources training programmes and strong human research subject protection programmes pertaining to clinical research. This would facilitate the establishment of a functional system that can be expected to lead to increased medical research innovation in Shenzhen.
Reporting quality of the Delphi technique in reporting guidelines: a protocol for a systematic analysis of the EQUATOR Network Library
Authors: Banno Masahiro , Tsujimoto Yasushi , Kataoka Yuki
Published: April 2019

Introduction

Reporting guidelines are important tools for improving the quality of medical research. The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network’s Library contains a comprehensive and up-to-date database of reporting guidelines relevant to health research. Only 31% of reporting guidelines published from 2010 to 2014 reported using the Delphi technique, and the reporting quality of the Delphi technique in reporting guidelines is unknown even though the use of the Delphi technique was recommended in the guidance for reporting guidelines. We will assess the quality reports of the Delphi technique or modified Delphi technique in reporting guidelines.

Methods and analysis

The present study is a systematic analysis of the EQUATOR Network Library. We will include all reporting guidelines in the EQUATOR Network that used the Delphi technique or modified Delphi technique, published since 1 January 2011 and registered in the EQUATOR on or before 31 May 2018. Our primary outcome is the reporting quality of the Delphi technique, measured by the quality score (each item) in the Delphi technique. We will also examine the relationship between the reporting quality score (each item) of the Delphi technique and year of publication, number of authors, impact factor, sources of funding (industry, non-industry), multiple publications and whether the guidelines are published in open access policy.

Ethics and dissemination

Ethics approval will not be applicable for this study. This protocol has been registered in the University Hospital Medical Information Network Clinical Trials Registry. We will publish our findings in a peer-reviewed journal and may also present them at conferences.

Trial registration number

UMIN000032685.
Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review
Authors: Kastner Monika , Hayden Leigh , Wong Geoff , Lai Yonda , Makarski Julie , Treister Victoria , Chan Joyce , Lee Julianne H , Ivers Noah M , Holroyd-Leduc Jayna , Straus Sharon E
Published: April 2019

Objectives

To understandhowandwhyeffective multi-chronic disease management interventions influence health outcomes in older adults 65 years of age or older.

Design

A realist review.

Data sources

Electronic databases including Medline and Embase (inception to December 2017); and the grey literature.

Eligibility criteria for selecting studies

We considered any studies (ie, experimental quasi-experimental, observational, qualitative and mixed-methods studies) as long as they provided data to explain our programme theories and effectiveness review (published elsewhere) findings. The population of interest was older adults (age ≥65 years) with two or more chronic conditions.

Analysis

We used the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and publication criteria for our synthesis aimed at refining our programme theories such that they contained multiple context-mechanism-outcome configurations describing the ways different mechanisms fire to generate outcomes. We created a 3-step synthesis process grounded in meta-ethnography to separate units of data from articles, and to derive explanatory statements across them.

Results

106 articles contributed to the analysis. We refined our programme theories to explain multimorbidity management in older adults: (1) care coordination interventions with the best potential for impact are team-based strategies,disease managementprogrammes andcase management; (2) optimised disease prioritisation involves ensuring that clinician work with patients to identify what symptoms are problematic and why, and to explore options that are acceptable to both clinicians and patients and (3) optimised patient self-management is dependent on patients’ capacity for selfcare and to what extent, and establishing what patients need to enable selfcare.

Conclusions

To optimise care, both clinical management and patient self-management need to be considered from multiple perspectives (patient, provider and system). To mitigate the complexities of multimorbidity management, patients focus on reducing symptoms and preserving quality of life while providers focus on the condition that most threaten morbidity and mortality.

PROSPERO registration number

CRD42014014489.
How universal are universal preschool health checks? An observational study using routine data from New Zealand’s B4 School Check
Authors: Gibb Sheree , Milne Barry , Shackleton Nichola , Taylor Barry J , Audas Richard
Published: April 2019

Objectives

We aimed to estimate how many children were attending a universal preschool health screen and to identify characteristics associated with non-participation.

Design

Analysis of population-level linked administrative data.

Participants

Children were considered eligible for a B4 School Check for a given year if:(1) they were ever resident in New Zealand (NZ),(2) lived in NZ for at least 6 months during the reference year, (3) were alive at the end of the reference year, (4) either appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing or general practitioner enrolment datasets during the reference year or (5) had a registered birth in NZ. We analysed 252 273 records over 4 years, from 1 July 2011 to 30 June 2015.

Results

We found that participation rates varied for each component of the B4 School Check (in 2014/2015 91.8% for vision and hearing tests (VHTs), 87.2% for nurse checks (including height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status) and 62.1% for SDQ – Teacher [SDQ-T]), but participation rates for all components increased over time. Māori and Pacific children were less likely to complete the checks than non-Māori and non-Pacific children (for VHTs: Māori: OR=0.60[95% CI 0.61 to 0.58], Pacific: OR=0.58[95% CI 0.60 to 0.56], for nurse checks: Māori: OR=0.63[95% CI 0.64 to 0.61], Pacific: OR=0.67[95% CI 0.69 to0.65] and for SDQ-T: Māori: OR=0.76[95% CI 0.78 to 0.75], Pacific: OR=0.37[95% CI 0.38 to 0.36]). Children from socioeconomically deprived areas, with younger mothers, from rented homes, residing in larger households, with worse health status and with higher rates of residential mobility were less likely to participate in the B4 School Check than other children.

Conclusion

The patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they potentially require. There needs to be an increased effort by public health organisations, community and whānau/family to ensure that all children are tested and screened.
Nutraceuticals and nutritional supplements for the treatment of bipolar disorder: protocol for a systematic review
Authors: Ashton Melanie M , Berk Michael , Ng Chee H , Hopwood Malcolm , Kavanagh Bianca , Williams Lana J , Sarris Jerome , Dean Olivia M
Published: April 2019

Introduction

First line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms?

Methods and analysis

Clinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.

Ethics and dissemination

This review will only look at published data (already reviewed for ethical compliance); therefore, ethical approval is not required. We aim to publish the systematic review in a peer-reviewed journal and present at conferences.

PROSPERO registration number

CRD42019100745.
University students’ understanding and perceptions of schizophrenia in the UK: a qualitative study
Authors: Cadge Charlotte , Connor Charlotte , Greenfield Sheila
Published: April 2019

Objective

To explore lay understanding and perceptions of schizophrenia in university students.

Design

Qualitative study using semi-structured interviews and thematic analysis.

Setting

The University of Birmingham, West Midlands.

Participants

20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1).

Results

Findings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause.

Conclusions

The university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.
Burden, risk factors and outcomes of hyperemesis gravidarum in low-income and middle-income countries (LMICs): systematic review and meta-analysis protocol
Authors: Dinberu Mesfin Tadese , Mohammed Mohammed Akibu , Tekelab Tesfalidet , Yimer Nigus Bililign , Desta Melaku , Habtewold Tesfa Dejenie
Published: April 2019

Introduction

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by excessive nausea and vomiting resulting in dehydration, weight loss and serious adverse pregnancy outcomes including termination of pregnancies. Even though evidence in low-income and middle-income countries (LMICs) is limited, the prevalence of HG in pregnancy ranges from 0.3% to 10.8%. With this systematic review and meta-analysis, we aim to determine the prevalence/burden, risk factors, and maternal and perinatal outcomes of HG in LMICs.

Methods

PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS databases will be searched. Reference lists of selected articles will be assessed in order to identify other potential studies of interest. Observational studies and (non) randomised controlled trials conducted from January 2000 to September 2018 in LMIC will be included. A weighted inverse-variance meta-analysis using fixed-effects and random-effects model will be done to generate a pooled estimate. Funnel plot and Egger’s regression statistical test will be applied to check publication bias. Heterogeneity among studies will be checked using Τ2to determine dispersion. Moreover, meta-regression analysis will be performed to investigate the source of heterogeneity. STATA V.14 will be used to analyse the data.

Ethics and dissemination

Formal ethical approval and patient consent are not required; as primary data collection will not be employed. The result will be published in a peer-reviewed scientific journal and will be presented at scientific conferences and public press.

PROSPERO registration number

CRD42018096284.
Effects of dexmedetomidine on delirium and mortality during sedation in ICU patients: a systematic review and meta-analysis protocol
Authors: Sun Rao , Wang Shuo , Li Shiyong , Yang Chun , Zhao Yilin , Luo Ailin
Published: April 2019

Introduction

Delirium is very common in patients admitted to intensive care unit (ICU), and may worsen survival in these patients. Several meta-analyses have evaluated the antidelirium effects of dexmedetomidine in ICU patients, but their findings were inconsistent. Recently, several large multicentre randomised clinical trials (RCTs) were published, but they have not yet to be included in any meta-analysis. We will conduct a meta-analysis adding these data to evaluate the effects of dexmedetomidine on delirium and mortality in ICU patients, aiming to terminate controversy and provide robust evidence for guiding clinical practice.

Methods and analysis

The Cochrane Central Register of Controlled Trials, PubMed, Embase, ISI Web of Science will be searched from inception to 31 December 2018 for relevant RCTs. Two reviewers will independently screen the identified citations. After quality appraisal and data extraction of included studies, we will conduct meta-analyses for outcomes of interest, including delirium, mortality, length of ICU/hospital stay, time to extubation, ICU costs and adverse effects. The statistical heterogeneity among studies will be assessed by the χ2test and quantified by the I2statistics. We will undertake subgroup analyses to explore heterogeneity and sensitivity analyses to evaluate whether the results are robust. Potential publication bias will be assessed by funnel plot and Egger’s test. At last, the quality of evidence of the main outcomes will be rated using the Grading of Recommendations Assessment, Development and Evaluation system.

Ethics and dissemination

The present study is a meta-analysis based on published studies, thus ethical approval is not needed. Our review will elucidate whether dexmedetomidine could decrease the incidence of delirium and improve survival in ICU patients. Our findings may help clinicians to choose optimal sedative agents for ICU patients. The results of this meta-analysis will be submitted to a peer reviewed journal for publication.

PROSPERO registration number

CRD42018095358.
Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study
Authors: Hashimoto Hideki , Matsui Hiroki , Sasabuchi Yusuke , Yasunaga Hideo , Kotani Kazuhiko , Nagai Ryozo , Hatakeyama Shuji
Published: April 2019

Objectives

To investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.

Design

Retrospective cohort study.

Setting

Database of public health insurance claims in Kumamoto prefecture (Japan).

Participants

Beneficiaries of the national or late elders’ health insurance system between April 2012 and March 2013.

Main outcome measures

Of the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10–19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.

Conclusions

Broad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.
Carotid endarterectomy with primary closure versus patch angioplasty in patients with symptomatic and significant stenosis: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials
Authors: Marsman Martijn S , Wetterslev Jørn , Jahrome Abdelkarime Khodadade , Gluud Christian , Moll Frans L , Karimi Amine , Keus Frederik , Koning Giel G
Published: April 2019

Introduction

Use of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis and trial sequential analysis as well as Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments comparing the benefits and harms of CEA with primary closure of the arterial wall versus CEA with patch angioplasty in patients with a symptomatic and significant carotid stenosis.

Methods and analysis

The review shall be conducted according to this published protocol following the recommendations of the ‘Cochrane’ and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Randomised clinical trials comparing CEA with primary closure of the arterial wall versus CEA with patch angioplasty (regardless of used patch materials) in human adults with a symptomatic and significant carotid stenosis will be included. Primary outcomes are all-cause mortality at maximal follow-up, health-related quality of life and serious adverse events. Secondary outcomes are symptomatic or asymptomatic arterial occlusion or restenosis, and non-serious adverse events. We will primarily base our conclusions on meta-analyses of trials with overall low risk of bias. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the precision achieved in all trials as the result of our meta-analyses.

Ethics and dissemination

The proposed systematic review will collect and analyse secondary data from published studies therefor ethical approval is not required. The results of the systematic review will be disseminated by publication in a peer-review journal and submitted for presentation at relevant conferences.

PROSPERO registration number

CRD42014013416.
Postoperative wound dehiscence after laparotomy: a useful healthcare quality indicator? A cohort study based on Norwegian hospital administrative data
Authors: Helgeland Jon , Tomic Oliver , Hansen Tonya Moen , Kristoffersen Doris Tove , Hassani Sahar , Lindahl Anne Karin
Published: April 2019

Objectives

Postoperative wound dehiscence (PWD) is a serious complication to laparotomy, leading to higher mortality, readmissions and cost. The aims of the present study are to investigate whether risk adjusted PWD rates could reliably differentiate between Norwegian hospitals, and whether PWD rates were associated with hospital characteristics such as hospital type and laparotomy volume.

Design

Observational study using patient administrative data from all Norwegian hospitals, obtained from the Norwegian Patient Registry, for the period 2011–2015, and linked using the unique person identification number.

Participants

All patients undergoing laparotomy, aged at least 15 years, with length of stay at least 2 days and no diagnosis code for immunocompromised state or relating to pregnancy, childbirth and puerperium. The final data set comprised 66 925 patients with 78 086 laparotomy episodes from 47 hospitals.

Outcomes

The outcome was wound dehiscence, identified by the presence of a wound reclosure code, risk adjusted for patient characteristics and operation type.

Results

The final data set comprised 1477 wound dehiscences. Crude PWD rates varied from 0% to 5.1% among hospitals, with an overall rate of 1.89%. Three hospitals with statistically significantly higher PWD than average were identified, after case mix adjustment and correction for multiple comparisons. Hospital volume was not associated with PWD rate, except that hospitals with very few laparotomies had lower PWD rates.

Conclusions

Among Norwegian hospitals, there is considerable variation in PWD rate that cannot be explained by operation type, age or comorbidity. This warrants further investigation into possible causes, such as surgical technique, perioperative procedures or handling of complications. The risk adjusted PWD rate after laparotomy is a candidate quality indicator for Norwegian hospitals.
What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial
Authors: Dismore Lorelle Louise , Echevarria Carlos , van Wersch Anna , Gibson John , Bourke Stephen
Published: April 2019

Objective

Hospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative study sought to identify facilitators and barriers to implementation of HAH.

Design

Semistructured interviews, data were analysed using thematic-construct analysis.

Setting

Interviews were conducted within patients’ homes and hospitals in North East England.

Participants

89 participants were interviewees; 44 patients, 15 carers, 15 physicians, 11 specialist nurses and 4 managers.

Results

Facilitators include the following: (1) availability of home comforts and maintaining independence (with positive influences on perceived rate of recovery, sleep quality and convenience for friends, family and carers) and (2) confidence in the continuity of HAH care. Barriers include the following: (1) fear of being alone at home; (2) privacy issues and not wanting visitors and (3) resistance to change. Clinician concerns occasionally delayed return home, principally during the early phase of the trial. Nurses cited higher workload and greater responsibility, but with additional resource and training; overall, they viewed HAH positively. Operational concerns included keeping medical records in a patient’s home and inability to capture activity within current payment systems.

Conclusion

HAH selected by DECAF was preferred to inpatient care by most patients and their families. Implementation in other hospitals will require education, training and service planning, tailored to overcome the identified barriers.

Trial registration number

ISRCTN29082260.
Psychometric properties of the Arabic version of the 9-item Shared Decision-Making Questionnaire: the entire process from translation to validation
Authors: Alzubaidi Hamzah , Hussein Amal , Mc Namara Kevin , Scholl Isabelle
Published: April 2019

Objective

To translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process.

Design

Multicentre cross-sectional study.

Setting

Secondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain).

Participants

Patients with chronic diseases who attended outpatient clinics of participating hospitals.

Measurements

The original German SDM-Q-9 was translated to Arabic. International multiphase translation guidelines and the process of cross-cultural adaptation of self-reported measures were used. Various psychometric properties were assessed, including reliability (internal consistency), and construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]).

Results

The final Arabic version of the SDM-Q-9 was tested among 516 secondary care patients. Internal consistency yielded a Cronbach’s alpha of 0.929 for the whole scale. EFA showed a one-factorial solution, Kaiser-Meyer-Olkin measure of sampling adequacy was 0.907 and Bartlett’s test of sphericity was significant (χ2=3413.69, df=36, p<0.0005). For the CFA, two different models were tested; Model 1 included the nine items and Model 2 was monofactorial that included items 2–9 and thus excluded item 1. Both models were adequate as they produced similar indices.

Conclusions

The Arabic version of SDM-Q-9 showed excellent reliability and acceptable validity parameters among secondary care patients. The newly translated Arabic questionnaire is the first psychometrically tested tool that can be used in the 22 member states of the Arab league to assess patients’ perspectives on the SDM process.
Hearing threshold levels and hearing loss among people in Zhejiang, China: a population-based cross-sectional study
Authors: Wang Dahui , Zhang Huai , Ma Haiyan , Zhang Long , Yang Lei , Xu Liangwen
Published: April 2019

Hearing loss (≥26 dB threshold in the better ear), as a common chronic condition in humans, is increasingly gaining attention. Relevant research in China is relatively scarce, so we conduct a population-based study to investigate the prevalence of hearing loss among age groups, genders and ears in Zhejiang province, China, from September 2016 to June 2018.

Study design

Population-based cross-sectional study

Participants

A total of 3754 participants aged 18–98 years and living in Zhejiang province, China.

Outcome measures

Pure-tone audiometric thresholds were measured at frequencies of 0.125–8 kHz for each subject. All participants were asked to complete a structured questionnaire, in the presence of a healthcare official.

Results

The prevalence of speech-frequency and high-frequency hearing loss was 27.9% and 42.9%, respectively, in Zhejiang. There were significant differences in auditory thresholds at most frequencies among the age groups, genders (male vs female: 31.6%vs24.1% at speech frequency; 48.9% vs 36.8% at high frequency) and ears. In addition to the common factors affecting both types of hearing loss, a significant correlation was found between personal income and speech-frequency hearing loss (OR=0.69, 95% CI 0.52 to 0.92), and between hyperlipidaemia and high-frequency hearing loss (OR=1.45, 95% CI 1.02 to 2.07).

Conclusion

The prevalence of hearing loss was high among people living in Zhejiang, particularly males, and in the left ear. Moreover, hearing thresholds increased with age. Several lifestyle and environment factors, which can be influenced by awareness and education, were significantly associated with hearing loss.
The National Cohort of Esophageal Cancer-Prospective Cohort Study of Esophageal Cancer and Precancerous Lesions based on High-Risk Population in China (NCEC-HRP): study protocol
Authors: Chen Ru , Ma Shanrui , Guan Chentao , Song Guohui , Ma Qing , Xie Shuanghua , Wang Meng , Shao Dantong , Li Xinqing , Wei Wenqiang
Published: April 2019

Introduction

Oesophageal cancer (OC) is one of the most common cancers worldwide and about 50% of all new cases occurred in China. Population-based screening has been conducted in high-risk areas in China since 1970s, however, a few factors have limited the integration of the results from previous studies and the sharing of existing resources, such as the difference in screening methods and protocols, inconsistencies in questionnaires for risk factors investigation, lack of standards for sample collection and incomplete follow-up information.

Methods and analysis

The National Cohort of Esophageal Cancer-Prospective Cohort Study of Esophageal Cancer and Precancerous Lesions based on High-Risk Population (NCEC-HRP) is a prospective cohort study of OC screening based on high-risk population in China supported by the National Key R&D Programme. Eight areas located at eastern, central and western China are selected as screening centres to represent three economical-geographical regions. All local residents aged 40–69 years in the selected areas are invited to take endoscopic examination and risk factors investigation unless they meet the exclusion criteria. The recruitment began on June 2017 and a total of 100 000 participants will be enrolled by December 2020 and all subjects will be followed for a long time. This study is designed as open-ended and has broad research aims. Summary statistics for baseline information will be reported after the completion of recruitment. We will develop a series of standards and guidelines for OC screening during the study. An open and shared research platform linked with epidemiological databases and biobank will be built up for further research.

Ethics and dissemination

The study is approved by the Ethics Committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (approval number 16-171/1250). The findings of the study will be disseminated through scientific peer-reviewed journals as well as the public via the study website (http://www.ncec-china.cn).

Trial registration number

ChiCTR-EOC-17010553; Pre-results.
Suffering measurement instruments in palliative care: protocol for a systematic psychometric review
Authors: Gutiérrez Sánchez Daniel , Gómez García Rafael , López-Medina Isabel María , Cuesta-Vargas Antonio I
Published: April 2019

Introduction

The prevention and relief of suffering are regarded as a goal at the end of life; therefore, suffering assessment at the end of life is essential. In this regard, we need instruments that allow us to evaluate this construct for gathering more evidence, as the assessment of suffering is increasingly used in research and the clinical setting. Many measures have been designed to assess this construct, and the selection of the most appropriate instrument is crucial. The aims of this systematic review are to (1) identify the measures assessing suffering in patients with advanced disease and their psychometric properties and (2) evaluate the methodological quality of studies on measurement properties.

Methods and analysis

The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guidelines. A systematic psychometric review of measures assessing suffering in patients with advanced disease and their psychometric properties will be carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). The search strategy will be performed following the Peer Review of Electronic Search Strategies. Searches will be conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Cochrane Library, SciELO, Open Grey, Scopus, Web of Science and COSMIN database of systematic reviews, and it will be limited by time (1980–2018) and language (only literature in English and Spanish). Literature will be evaluated by two independent reviewers according to the COSMIN checklist, and measurement properties data of each study that meet the inclusion criteria will be scored independently by two researchers according to COSMIN quality ratings.

Ethics and dissemination

Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference.

PROSPERO registration number

CRD42018106488.
Health-related quality of life after camp-based family obesity treatment: an RCT
Authors: Benestad Beate , Karlsen Tor-Ivar , Småstuen Milada Cvancarova , Lekhal Samira , Hertel Jens Kristoffer , Steinsbekk Silje , Kolotkin Ronette L , Ødegård Rønnaug Astri , Hjelmesæth Jøran
Published: April 2019

Objective

To compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.

Design

Randomised controlled trial.

Setting

Rehabilitation clinic, tertiary care hospital and primary care.

Patients

Families with at least one child (7–12 years) and one parent, both with obesity.

Interventions

Summer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle.

Main outcome measures

Children’s and parents’ HRQoL were assessed using generic and obesity-specific measures. Outcomes were analysed using linear mixed models according to intention to treat, and multiple imputations were used for missing data.

Results

Ninety children (50% girls) with a mean (SD) age of 9.7 (1.2) years and body mass index 28.7 (3.9) kg/m2 were included in the analyses. Summer camp children had an estimated mean (95% CI) of 5.3 (0.4 to 10.1) points greater improvement in adiposity-specific HRQoL score at 2 years compared with the lifestyle school children, and this improvement was even larger in the parent proxy-report, where mean difference was 7.3 (95% CI 2.3 to 12.2). Corresponding effect sizes were 0.33 and 0.44. Generic HRQoL questionnaires revealed no significant differences between treatment groups in either children or parents from baseline to 2 years.

Conclusions

A 2-year family camp-based immersion obesity treatment programme had significantly larger effects on obesity-specific HRQoL in children’s self-report and parent proxy-reports in children with obesity compared with an outpatient family-based treatment programme.

Trial registration number

NCT01110096.
Prevalence of depression in patients with cancer in Iran: a systematic review and meta-analysis
Authors: Aryankhesal Aidin , Ghashghaee Ahmad , Sardari Elnaz , Mahmoudi Sara , Alihosseini Samira , Dehnad Afsaneh , Roohravan Benis Mahshid , Gharagozlou Dorsa
Published: April 2019

Introduction

It is generally accepted that depression, affecting the quality of life, is a serious and common complication in patients with cancer. Given that there is no integrated study on this topic in Iran, the present study sought to investigate the prevalence of depression in patients with cancer by a systematic review and meta-analysis.

Methods

To meet the study objectives, all English and Persian papers published from 2000 to January 2018 were systematically collected and the data were extracted for analysis.

Results

There were 14 studies which were selected on the basis of the inclusion and exclusion criteria. A total number of 2831 patients with cancer had participated in the studies. The prevalence of depression among Iranian patients with cancer was 35% (95% CI 16% to 70%) based on random effects model. Among various types of cancer, the highest prevalence of depression appeared to patients suffering from breast cancer.

Conclusion

The prevalence of depression among patients with cancer in Iran was higher than the developed countries. As depression affects the quality of life of patients with cancer, the results can help policymakers and service providers in planning to reduce the prevalence of depression.