bluuebunny/crossref_metadata_2025 huggingface dataset:
Manipulating surface magnetic order in iron telluride
Authors: Trainer Christopher , Yim Chi M. , Heil Christoph , Giustino Feliciano , Croitori Dorina , Tsurkan Vladimir , Loidl Alois , Rodriguez Efrain E. , Stock Chris , Wahl Peter
Published: March 2019

Manipulation of the surface composition of a strongly correlated electron material enables control of the magnetic order.
Ultrafast electron calorimetry uncovers a new long-lived metastable state in 1
T
-TaSe
2
mediated by mode-selective electron-phonon coupling
Authors: Shi Xun , You Wenjing , Zhang Yingchao , Tao Zhensheng , Oppeneer Peter M. , Wu Xianxin , Thomale Ronny , Rossnagel Kai , Bauer Michael , Kapteyn Henry , Murnane Margaret
Published: March 2019

Ultrafast laser pulses uncover a new metastable state in 1
T
-TaSe
2
by exciting electrons and then tracking their temperature.
Experimentally reducing the quantum measurement back action in work distributions by a collective measurement
Authors: Wu Kang-Da , Yuan Yuan , Xiang Guo-Yong , Li Chuan-Feng , Guo Guang-Can , Perarnau-Llobet Martí
Published: March 2019

A new measurement scheme for reducing quantum measurement back action is experimentally realized.
Structure and function of the immune system in the spleen
Authors: Lewis Steven M. , Williams Adam , Eisenbarth Stephanie C.
Published: March 2019

The spleen is a multitasking secondary lymphoid organ with specialized cells for initiating immunity to blood-borne targets.
Tissue clonality of dendritic cell subsets and emergency DCpoiesis revealed by multicolor fate mapping of DC progenitors
Authors: Cabeza-Cabrerizo Mar , van Blijswijk Janneke , Wienert Stephan , Heim Daniel , Jenkins Robert P. , Chakravarty Probir , Rogers Neil , Frederico Bruno , Acton Sophie , Beerling Evelyne , van Rheenen Jacco , Clevers Hans , Schraml Barbara U. , Bajénoff Marc , Gerner Michael , Germain Ronald N. , Sahai Erik , Klauschen Frederick , Reis e Sousa Caetano
Published: March 2019

Many tissue cDCs are maintained as single subset clones, which disperse upon infection with acute recruitment of pre-cDCs.
T cells have seen it all before
Authors: Griffin Gabriel K.
Published: March 2019

Two recent studies demonstrate widespread preexisting immunity to Cas9 in healthy adults.
The Dynamic Structures of the Type IV Pilus
Authors: McCallum Matthew , Burrows Lori L. , Howell P. Lynne
Published: March 2019

Type IV pilus (T4P)-like systems have been identified in almost every major phylum of prokaryotic life. They include the type IVa pilus (T4aP), type II secretion system (T2SS), type IVb pilus (T4bP), Tad/Flp pilus, Com pilus, and archaeal flagellum (archaellum). These systems are used for adhesion, natural competence, phage adsorption, folded-protein secretion, surface sensing, swimming motility, and twitching motility. The T4aP allows for all of these functions except swimming and is therefore a good model system for understanding T4P-like systems. Recent structural analyses have revolutionized our understanding of how the T4aP machinery assembles and functions. Here we review the structure and function of the T4aP.
Type VI Secretion Systems and the Gut Microbiota
Authors: Coyne Michael J. , Comstock Laurie E.
Published: March 2019

The human colonic microbiota is a dense ecosystem comprised of numerous microbes, including bacteria, phage, fungi, archaea, and protozoa, that compete for nutrients and space. Studies are beginning to reveal the antagonistic mechanisms that gut bacteria use to compete with other members of this ecosystem. In the healthy human colon, the majority of the Gram-negative bacteria are of the order
Bacteroidales
. Proteobacteria, such as
Escherichia coli
, are numerically fewer but confer important properties to the host, such as colonization resistance. Several enteric pathogens use type VI secretion systems (T6SSs) to antagonize symbiotic gut
E. coli
, facilitating colonization and disease progression. T6SS loci are also widely distributed in human gut
Bacteroidales
, which includes three predominant genera:
Bacteroides
,
Parabacteroides
, and
Prevotella
. There are three distinct genetic architectures of T6SS loci among the gut
Bacteroidales
, termed GA1, GA2, and GA3. GA1 and GA2 T6SS loci are contained on integrative and conjugative elements and are the first T6SS loci shown to be readily transferred in the human gut between numerous species and families of
Bacteroidales
. In contrast, the GA3 T6SSs are present exclusively in
Bacteroides fragilis
. There are divergent regions in all three T6SS GAs that contain genes encoding effector and immunity proteins, many of which function by unknown mechanisms. To date, only the GA3 T6SSs have been shown to antagonize bacteria, and they target nearly all gut
Bacteroidales
species analyzed. This review delves more deeply into properties of the T6SSs of these human gut bacteria and the ecological outcomes of their synthesis
in vivo
.
Astronomical pacing of relative sea level during Oceanic Anoxic Event 2: Preliminary studies of the expanded SH#1 Core, Utah, USA
Authors: Jones Matthew M. , Sageman Bradley B. , Oakes Rosie L. , Parker Amanda L. , Leckie R. Mark , Bralower Timothy J. , Sepúlveda Julio , Fortiz Victoria
Published: March 2019

Proximal marine strata of the North American Western Interior Basin (WIB) preserve a rich record of biotic turnover during Oceanic Anoxic Event 2 (OAE2; ca. 94 Ma), a pronounced Late Cretaceous carbon cycle perturbation interpreted to reflect global warming, widespread hypoxia, and possible ocean acidification. To develop a more robust synthesis of paleobiologic and geochemical data sets spanning this Earth-life transition, we drilled the 131 m Smoky Hollow #1 Core (SH#1), on the Kaiparowits Plateau of southern Utah, USA, recovering the Cenomanian–Turonian Boundary (CTB) interval in the Tropic Shale Formation. A 17.5 m positive excursion in high-resolution bulk carbon isotope chemostratigraphy (δ13Corg) of SH#1 characterizes the most expanded OAE2 record recovered from the mid-latitudes of the WIB.

Depleted values in a paired carbonate carbon isotope (δ13Ccarb) chemostratigraphy cyclically punctuate the OAE2 excursion. These depletions correspond to intervals in the core with a higher degree of carbonate diagenesis and correlate well to an existing sequence stratigraphic framework of flooding surfaces in the shoreface facies of the Markagunt Plateau (∼100 km west). We detect statistically significant evidence for astronomical cycles in the δ13Ccarb data set, imparted by diagenesis at flooding surfaces, and develop a floating astronomical time scale (ATS) for the study interval. Stable eccentricity cycles (405 k.y.) align with stratigraphic sequences and associated trends in sedimentation rate, and short eccentricity cycles (∼100 k.y.) pace nested parasequences. These results confirm an astronomical signal and, therefore, climatic forcing of relative sea level during OAE2 in the WIB. Furthermore, cross-basin correlation of the ATS and expanded δ13C chemostratigraphy of SH#1 suggests that these transgressive-regressive parasequences modulated siliciclastic sediment delivery in the seaway and contributed to deposition of prominent rhythmically bedded CTB units across the WIB, including the Bridge Creek Limestone. The presented approach to analysis of these proximal offshore siliciclastic facies links early diagenetic influences on chemostratigraphy to astronomically modulated sequence stratigraphic horizons, and helps to resolve rates of paleobiologic and paleoenvironmental change during a significant Mesozoic carbon cycle perturbation.
Could coenzyme Q10 be the treatment for Dupuytren’s disease?
Authors: Lourens Wilma
Published: March 2019

A patient with Dupuytren’s disease noted progressive disappearance of the contractures of both hands over a 3-year period while taking coenzyme Q10 daily for an unrelated condition. The function and appearance of his hands were restored to almost normal.
Garbled speech: a rare presentation of metronidazole-induced neurotoxicity
Authors: Cheema Muhammad Arslan , Salman FNU , Ullah Waqas , Zain Muhammad Abdullah
Published: March 2019

Neurotoxicity is a rare but significant side effect of metronidazole. We present, here, a case of a 34-year-old man, presenting with garbled speech and word finding difficulty. He was taking metronidazole for the last 3 months for stage 4 decubitus ulcers. MRI of the brain showed abnormal signal intensities in the splenium of the corpus callosum and dentate nuclei of the cerebellum. The diagnosis of metronidazole-induced neurotoxicity was made based on MRI findings. The antibiotic was stopped leading to resolution of abnormal MRI findings. We advocate that metronidazole can be associated with severe neurotoxicity, but its prompt cessation leads to better outcome and prognosis.
Adenovirus cerebellitis in an immunocompetent 2-year-old girl
Authors: Tansley-Ahmed Zena , Wu Kit , Christodoulou Loucas
Published: March 2019

Acute cerebellitis (AC) is a principal cause of acute cerebellar dysfunction in previously well children. Although the condition is usually benign, fatal complications include obstructive hydrocephalus and brainstem compression; therefore, prompt accurate diagnosis is vital.1There are various pathogens reported in the literature as aetiological agents of AC; however, adenovirus is very rarely mentioned, with only one previous case report in the literature to the best of our knowledge.2This case demonstrates the importance of recognising adenovirus as a cause of AC, particularly when preceded by a respiratory tract infection in the paediatric age group. Furthermore, we highlight the role of early neuroimaging in differentiating AC from other causes of acute cerebellar dysfunction, which require different management. Our patient made a full recovery with no long-term deficits demonstrating that comprehensive investigation and consideration of atypical pathogens in the context of AC is vital in securing a favourable outcome.
Cervical necrotising fasciitis: a rare complication of infectious mononucleosis
Authors: Din-Lovinescu Corina , Berg Howard
Published: March 2019

Cervical necrotising fasciitis (NF) is an aggressive polymicrobial infection of the subcutaneous tissues in the head and neck. We present a case of a healthy 19-year-old man who developed cervical and upper mediastinal NF after an initial presentation of infectious mononucleosis (IM). He was treated with broad-spectrum antibiotics in addition to incision and drainage of an anterior neck and upper mediastinal abscess. He progressed favourably after ten days of hospitalisation and was discharged home on intravenous antibiotics. This is a unique case of cervical NF as a sequelae of IM in a previously healthy paediatric patient.
c-ANCA vasculitis after initiation of denosumab
Authors: Sanchez Alexandra , Lozier Matthew , Adkinson Brian Cody , Ilaiwy Amro
Published: March 2019

Denosumab is a fully human antibody to receptor activator of nuclear factor kappa-B ligand (RANKL), and it is administered every 6 months in women with postmenopausal osteoporosis (PMO) at high risk for fracture. Adverse effects of denosumab include musculoskeletal pain, hypercholesterolaemia, symptomatic hypocalcaemia, osteonecrosis of the jaw and cutaneous events such as angioedema, cellulitis and pustular dermatitis. While the possibility of vasculitis was mentioned in the product Monograph as well as in the WHO Newsletter, this is the first case, to our knowledge, of cytoplasmic-ANCA (c-ANCA) associated vasculitis officially published in the literature.1 2The pathogenic mechanisms behind drug-induced vasculitis remain to be defined and appear to be multifactorial. Once suspicion for drug-induced vasculitis arises, the offending agent should be discontinued and immunosuppressive therapy should be initiated according to the severity of organ involvement to inhibit progression to severe, irreversible disease. As new medications continue to be developed, the number of agents causing drug-induced vasculitis is expected to increase.
The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature
Authors: O'Donovan James , Verkerk Misha , Winters Niall , Chadha Shelly , Bhutta Mahmood F
Published: March 2019

Introduction

Community health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs.

Methods

We performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature.

Results

We identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss.

Conclusion

CHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.
Local patterns of social capital and sustenance of the Community-Based Health Planning Services (CHPS) policy: a qualitative comparative study in Ghana
Authors: Amoah Padmore Adusei
Published: March 2019

Objective

Social capital—the resources embedded in social relationships—has been associated with health severally. Notwithstanding, only a handful of studies have empirically examined how it shapes health policies. This paper extends the discourse by comparatively examining how variations in local patterns of structural and cognitive social capital underpin the successes and challenges in managing and sustaining the Community-Based Health Planning Services (CHPS) policy in Ghana. The CHPS is an intervention to address health inequalities.

Design

Qualitative study involving individual in-depth interviews and focus group discussions using a semi-structured interview guide. Thematic analysis approach, inspired by McConnell’s typology of policy success (or failure) was adopted.

Setting

Two rural communities in two districts in Ashanti region in Ghana.

Participants

Thirty-two primary participants as well as four health personnel and four traditional and political leaders.

Results

Both structural and cognitive components of social capital underpinned efficient functioning of the CHPS initiative regarding funding, patronage and effective information transmission. Sufficient level of social capital in a community enhanced understanding of the nature and purpose of the CHPS policy as well as complementary ones such as the referral policy. Contrary to popular conclusions, it was discovered that the influence of social capital was not necessarily embedded in its quantity but the extent of conscious activation and application. Furthermore, the findings contravened the assertion that social capital may be less potent in small-sized communities. However, elevated levels of cognitive social capital encouraged people to access the CHPS on credit or even for free, which was injurious to its sustenance.

Conclusion

The CHPS initiative, and pro-poor policies alike, are more likely to thrive in localities with sufficient structural and cognitive social capital. Lack of it may render the CHPS susceptible to recurrent, yet preventable challenges.
PARROT Ireland: Placental growth factor in Assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a Stepped Wedge Cluster Randomised Control Trial Research Study Protocol
Authors: Hayes-Ryan Deirdre , Hemming Karla , Breathnach Fionnaula , Cotter Amanda , Devane Declan , Hunter Alyson , McAuliffe Fionnuala M , Morrison John J , Murphy Deirdre J , Khashan Ali , McElroy Brendan , Murphy Aileen , Dempsey Eugene , O’Donoghue Keelin , Kenny Louise C
Published: March 2019

Introduction

Women presenting with suspected pre-eclampsia are currently triaged on the basis of hypertension and dipstick proteinuria. This may result in significant false positive and negative diagnoses resulting in increased morbidity or unnecessary intervention. Recent data suggest that placental growth factor testing may be a useful adjunct in the management of women presenting with preterm pre-eclampsia. The primary objective of this trial is to determine if the addition of placental growth factor testing to the current clinical assessment of women with suspected preterm pre-eclampsia, is beneficial for both mothers and babies.

Methods and analysis

This is a multicentre, stepped wedge cluster, randomised trial aiming to recruit 4000 women presenting with symptoms suggestive of preterm pre-eclampsia between 20 and 36+6 weeks’ gestation. The intervention of an unblinded point of care test, performed at enrolment, will quantify maternal levels of circulating plasma placental growth factor. The intervention will be rolled out sequentially, based on randomisation, in the seven largest maternity units on the island of Ireland. Primary outcome is a composite outcome of maternal morbidity (derived from the modified fullPIERS model). To ensure we are not reducing maternal morbidity at the expense of earlier delivery and worse neonatal outcomes, we have established a co-primary outcome which will examine the effect of the intervention on neonatal morbidity, assessed using a composite neonatal score. Secondary analyses will examine further clinical outcomes (such as mode of delivery, antenatal detection of growth restriction and use of antihypertensive agents) as well as a health economic analysis, of incorporation of placental growth factor testing into routine care.

Ethics and dissemination

Ethical approval has been granted from each of the seven maternity hospitals involved in the trial. The results of the trial will be presented both nationally and internationally at conference and published in an international peer-reviewed journal.

Trial registration number

NCT02881073.
Geographical inequalities in acute myocardial infarction beyond neighbourhood-level and individual-level sociodemographic characteristics: a Danish 10-year nationwide population-based cohort study
Authors: Kjærulff Thora Majlund , Bihrmann Kristine , Andersen Ingelise , Gislason Gunnar Hilmar , Larsen Mogens Lytken , Ersbøll Annette Kjær
Published: March 2019

Objective

This study examined whether geographical patterns in incident acute myocardial infarction (AMI) were explained by neighbourhood-level and individual-level sociodemographic characteristics.

Design

An open cohort study design of AMI-free adults (age ≥30 years) with a residential location in Denmark in 2005–2014 was used based on nationwide administrative population and health register data linked by the unique personal identification number. Poisson regression of AMI incidence rates (IRs) with a geographical random effect component was performed using a Bayesian approach. The analysis included neighbourhood-level variables on income, ethnic composition, population density and population turnover and accounted for individual-level age, sex, calendar year, cohabitation status, income and education.

Setting

Residents in Denmark (2005–2014).

Participants

The study population included 4 128 079 persons (33 907 796 person-years at risk) out of whom 98 265 experienced an incident AMI.

Outcome measure

Incident AMI registered in the National Patient Register or the Register of Causes of Death.

Results

Including individual and neighbourhood sociodemographic characteristics in the model decreased the variation in IRs of AMI. However, living in certain areas was associated with up to 40% increased IRs of AMI in the adjusted model and accounting for sociodemographic characteristics only moderately changed the geographical disease patterns.

Conclusions

Differences in sociodemographic characteristics of the neighbourhood and individuals explained part, but not all of the geographical inequalities in incident AMI. Prevention strategies should address the confirmed social inequalities in incident AMI, but also target the areas with a heavy disease burden to enable efficient allocation of prevention resources.
Nursing students’ experiences with faculty incivility in the clinical education context: a qualitative systematic review and meta-synthesis
Authors: Zhu Zheng , Xing Weijie , Lizarondo Lucylynn , Guo Mengdi , Hu Yan
Published: March 2019

Objective

The aim of this study is to synthesise evidence for the experiences and perceptions of incivility during clinical education of nursing students.

Design

We used a meta-aggregation approach to conduct a systematic review of qualitative studies.

Data sources

Published and unpublished papers from 1990 until 13 January 2018 were searched using electronic databases, including CINAHL, PubMed (MEDLINE), ProQuest Central, ProQuest Education Journals, ProQuest XML-Dissertations and Theses, Web of Science, Embase, EBSCO Discovery Service and PsycINFO. The search for unpublished studies included the Open Grey collection, conference proceedings and the Deep Blue Library.

Eligibility criteria

We included qualitative studies that focused on nursing students' perceptions and experiences of incivility from faculty during their clinical education.

Data extraction and synthesis

Two reviewers independently appraised the methodological quality and extracted relevant data from each included study. Meta-aggregation was used to synthesise the data.

Results

A total of 3397 studies was returned from the search strategies. Eighteen studies fulfilled the inclusion criteria and were included in the meta-synthesis. Six synthesised findings were identified, covering features of incivility, manifestations of incivility, contributing factors, impacts on students, coping strategies and suggestions.

Conclusions

The results showed experiences of incivility during clinical education. However, the confidence was low for all synthesised findings. We suggest that nursing students should try to cope positively with incivility. Nurse managers and clinical preceptors should be aware of the prevalence and impact of incivility and implement policies and strategies to reduce incivility towards nursing students. Hospitals and universities should have an immediate response person or system to help nursing students confronting incivility and create an open communication environment.
Analysis and reporting of adverse events in randomised controlled trials: a review
Authors: Phillips Rachel , Hazell Lorna , Sauzet Odile , Cornelius Victoria
Published: March 2019

Objective

To ascertain contemporary approaches to the collection, reporting and analysis of adverse events (AEs) in randomised controlled trials (RCTs) with a primary efficacy outcome.

Design

A review of clinical trials of drug interventions from four high impact medical journals.

Data sources

Electronic contents table of theBMJ, theJournal of the American Medical Association (JAMA), theLancetand theNew England Journal of Medicine (NEJM)were searched for reports of original RCTs published between September 2015 and September 2016.

Methods

A prepiloted checklist was used and single data extraction was performed by three reviewers with independent check of a randomly sampled subset to verify quality. We extracted data on collection methods, assessment of severity and causality, reporting criteria, analysis methods and presentation of AE data.

Results

We identified 184 eligible reports (BMJn=3;JAMAn=38,Lancetn=62 andNEJMn=81). Sixty-two per cent reported some form of spontaneous AE collection but only 29% included details of specific prompts used to ascertain AE data. Numbers that withdrew from the trial were well reported (80%), however only 35% of these reported whether withdrawals were due to AEs. Results presented and analysis performed was predominantly on ‘patients with at least one event’ with 84% of studies ignoring repeated events. Despite a lack of power to undertake formal hypothesis testing, 47% performed such tests for binary outcomes.

Conclusions

This review highlighted that the collection, reporting and analysis of AE data in clinical trials is inconsistent and RCTs as a source of safety data are underused. Areas to improve include reducing information loss when analysing at patient level and inappropriate practice of underpowered multiple hypothesis testing. Implementation of standard reporting practices could enable a more accurate synthesis of safety data and development of guidance for statistical methodology to assess causality of AEs could facilitate better statistical practice.
Targeted therapies for previously treated advanced or metastatic renal cell carcinoma: systematic review and network meta-analysis
Authors: Karner Charlotta , Kew Kayleigh , Wakefield Victoria , Masento Natalie , Edwards Steven J
Published: March 2019

Objective

To compare the effectiveness and safety of treatments for advanced or metastatic renal cell carcinoma (amRCC) after treatment with vascular endothelial growth factor (VEGF)-targeted treatment.

Design

Systematic review and network meta-analysis of randomised controlled trials (RCTs) and comparative observational studies. MEDLINE, EMBASE and Cochrane Library were searched up to January 2018.

Participants

People with amRCC requiring treatment after VEGF-targeted treatment.

Interventions

Axitinib, cabozantinib, everolimus, lenvatinib with everolimus, nivolumab, sorafenib and best supportive care (BSC).

Outcomes

Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes were objective response rate (ORR), adverse events, and health-related quality of life (HRQoL).

Results

Twelve studies were included (n=5144): five RCTs and seven observational studies. Lenvatinib with everolimus significantly increased OS and PFS over everolimus (HR 0.61, 95% Credible Interval [95%CrI]: 0.36 to 0.96 and 0.47, 95%CrI: 0.26 to 0.77, respectively) as did cabozantinib (HR 0.66, 95%CrI: 0.53 to 0.82 and 0.51, 95%CrI: 0.41 to 0.63, respectively). This remained the case when observational evidence was included. Nivolumab also significantly improved OS versus everolimus (HR 0.74, 95%CrI: 0.57 to 0.93). OS sensitivity analysis, including observational studies, indicates everolimus being more effective than axitinib and sorafenib. However, inconsistency was identified in the OS sensitivity analysis. PFS sensitivity analysis suggests axitinib is more effective than everolimus, which may be more effective than sorafenib. The results for ORR supported the OS and PFS analyses. Nivolumab is associated with fewer grade 3 or grade 4 adverse events than lenvatinib with everolimus or cabozantinib. HRQoL could not be analysed due to differences in tools used.

Conclusions

Lenvatinib with everolimus, cabozantinib and nivolumab are effective in prolonging the survival for people with amRCC subsequent to VEGF-targeted treatment, but there is considerable uncertainty about how they compare to each other and how much better they are than axitinib and sorafenib.

PROSPERO registrationnumber

CRD42017071540.
Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors
Authors: Krusche Adele , Bradbury Katherine , Corbett Teresa , Barnett Jane , Stuart Beth , Yao Guiqing Lily , Bacon Roger , Böhning Dankmar , Cheetham-Blake Tara , Eccles Diana , Foster Claire , Geraghty Adam William Alfred , Leydon Geraldine , Müller Andre , Neal Richard D , Osborne Richard , Rathod Shanaya , Richardson Alison , Sharman Geoffrey , Summers Kevin , Watson Eila , Wilde Laura , Wilkinson Clare , Yardley Lucy , Little Paul
Published: March 2019

Introduction

Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management.

Methods and analysis

A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support.

Ethics and dissemination

The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations.

Trial registration number

ISRCTN96374224; Pre-results.
Development of a core outcome set for behavioural weight management programmes for adults with overweight and obesity: protocol for obtaining expert consensus using Delphi methodology
Authors: Mackenzie Ruth M , Ells Louisa J , Simpson Sharon Anne , Logue Jennifer
Published: March 2019

Introduction

Weight management interventions in research studies and in clinical practice differ in length, advice, frequency of meetings, staff and cost. Very few real-world programmes have published patient-related outcomes, and those that have published used different ways of reporting the information, making it impossible to compare interventions and further develop the evidence base. Developing a core outcome set for behavioural weight management programmes (BWMPs) for adults with overweight and obesity will allow different BWMPs to be compared and reveal which interventions work best for which members of the population.

Methods and analysis

An expert group, comprised of 40 people who work in, refer to, or attend BWMPs for adults with overweight and obesity, will be asked to decide which outcomes services should report. An online Delphi process will be employed to help the group reach consensus as to which outcomes should be measured and reported, and which definitions/instruments should be used in order to do so. The first stage of the Delphi process (three rounds of questionnaires) will focus on outcomes while the second stage (three additional rounds of questionnaires) will focus on definition/instrument selection.

Ethics and dissemination

Ethical approval for this study has been received from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee. With regard to disseminating results, a report will be submitted to our funding body, the Chief Scientist Office of the Scottish Government Health Department. In addition, early findings will be shared with Public Health England and Health Scotland, and results communicated via conference presentations, peer review publication and our institutions’ social media platforms.
Crew resource management training in healthcare: a systematic review of intervention design, training conditions and evaluation
Authors: Gross Benedict , Rusin Leonie , Kiesewetter Jan , Zottmann Jan M , Fischer Martin R , Prückner Stephan , Zech Alexandra
Published: March 2019

Objectives

Crew resource management (CRM) training formats have become a popular method to increase patient safety by consideration of the role that human factors play in healthcare delivery. The purposes of this review were to identify what is subsumed under the label of CRM in a healthcare context and to determine how such training is delivered and evaluated.

Design

Systematic review of published literature.

Data sources

PubMed, PsycINFO and ERIC were searched through 8 October 2018.

Eligibility criteria for selecting studies

Individually constructed interventions for healthcare staff that were labelled as CRM training, or described as based on CRM principles or on aviation-derived human factors training. Only studies reporting both an intervention and results were included.

Data extraction and synthesis

The studies were examined and coded for relevant passages. Characteristics regarding intervention design, training conditions and evaluation methods were analysed and summarised both qualitatively and quantitatively.

Results

Sixty-one interventions were included. 48% did not explain any keyword of their CRM intervention to a reproducible detail. Operating room teams and surgery, emergency medicine, intensive care unit staff and anaesthesiology came in contact most with a majority of the CRM interventions delivered in a 1-day or half-day format. Trainer qualification is reported seldomly. Evaluation methods and levels display strong variation.

Conclusions

Critical topics were identified for the CRM training community and include the following: the need to agree on common terms and definitions for CRM in healthcare, standards of good practice for reporting CRM interventions and their effects, as well as the need for more research to establish non-educational criteria for success in the implementation of CRM in healthcare organisations.
Application of speCtraL computed tomogrAphy to impRove specIficity of cardiac compuTed tomographY (CLARITY study): rationale and design
Authors: van Hamersvelt Robbert Willem , Išgum Ivana , de Jong Pim A , Cramer Maarten Jan Maria , Leenders Geert E H , Willemink Martin J , Voskuil Michiel , Leiner Tim
Published: March 2019

Introduction

Anatomic stenosis evaluation on coronary CT angiography (CCTA) lacks specificity in indicating the functional significance of a stenosis. Recent developments in CT techniques (including dual-layer spectral detector CT [SDCT] and static stress CT perfusion [CTP]) and image analyses (including fractional flow reserve [FFR] derived from CCTA images [FFRCT] and deep learning analysis [DL]) are potential strategies to increase the specificity of CCTA by combining both anatomical and functional information in one investigation. The aim of the current study is to assess the diagnostic performance of (combinations of) SDCT, CTP, FFRCTand DL for the identification of functionally significant coronary artery stenosis.

Methods and analysis

Seventy-five patients aged 18 years and older with stable angina and known coronary artery disease and scheduled to undergo clinically indicated invasive FFR will be enrolled. All subjects will undergo the following SDCT scans: coronary calcium scoring, static stress CTP, rest CCTA and if indicated (history of myocardial infarction) a delayed enhancement acquisition. Invasive FFR of ≤0.80, measured within 30 days after the SDCT scans, will be used as reference to indicate a functionally significant stenosis. The primary study endpoint is the diagnostic performance of SDCT (including CTP) for the identification of functionally significant coronary artery stenosis. Secondary study endpoint is the diagnostic performance of SDCT, CTP, FFRCTand DL separately and combined for the identification of functionally significant coronary artery stenosis.

Ethics and dissemination

Ethical approval was obtained. All subjects will provide written informed consent. Study findings will be disseminated through peer-reviewed conference presentations and journal publications.

Trial registration number

NCT03139006; Pre-results.
Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study
Authors: Nishimura Rimei , Kato Haruka , Kisanuki Koichi , Oh Akinori , Hiroi Shinzo , Onishi Yoshie , Guelfucci Florent , Shimasaki Yukio
Published: March 2019

Objective

To determine real-world trends in antidiabetic drug use, and persistence and adherence, in Japanese patients with type 2 diabetes mellitus (T2DM).

Design

Retrospective evaluation of administrative claims data (2011–2015) using the Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases.

Setting

Analysis of two administrative claims databases for Japanese patients with T2DM.

Participants

Adults (aged ≥18 years) with an International Classification of Diseases, 10th Revision code of T2DM and at least one antidiabetic drug prescription.

Main outcome measures

Treatment patterns in untreated (UT) or previously treated (PT) patients receiving antidiabetic therapy; persistence with treatment at 12 months; adherence to treatment at 12 months.

Results

40 908 and 90 421 patients were included from the JMDC and MDV databases, respectively. The most frequently prescribed therapy at the index (first prescription) date was dipeptidyl peptidase-4 inhibitor (DPP-4i) in UT patients (JMDC: 44.0%, MDV: 54.8%) and combination therapy in PT patients (74.6%, 81.1%). Most common combinations were DPP-4i plus: biguanide (BG; 11.4%, 10.9%), sulfonylurea (SU; 8.4%, 11.0%) or BG+SU (7.8%, 9.1%). In UT or PT patients from either database whose index prescription was for any antidiabetic drug class(es) other than DPP-4i, the most frequent add-on or switch was to DPP-4i. 12-month persistence with index monotherapy was highest with DPP-4i and BG. Adherence was high (≥80%) for all monotherapy schedules, except insulin and glucagon-like peptide-1 agonist, and for the five most frequent two-drug and three-drug combinations. Persistence was greater in elderly UT patients and in those receiving ≤5 medications, but comparatively worse in UT patients with ≥3 index antidiabetic drug classes.

Conclusions

The findings indicate that DPP-4i is the most commonly used antidiabetic drug class in Japanese patients with T2DM, and persistence and adherence to this antidiabetic drug class are high.
Protocol for developing quality assurance measures to use in surgical trials: an example from the ROMIO study
Authors: Blencowe Natalie S , Skilton Anni , Gaunt Daisy , Brierley Rachel , Hollowood Andrew , Dwerryhouse Simon , Higgs Simon , Robb William , Boddy Alex , Hanna George , Barham C Paul , Blazeby Jane
Published: March 2019

Introduction

Randomised controlled trials (RCTs) in surgery are frequently criticised because surgeon expertise and standards of surgery are not considered or accounted for during study design. This is particularly true in pragmatic trials (which typically involve multiple centres and surgeons and are based in ‘real world’ settings), compared with explanatory trials (which are smaller and more tightly controlled).

Objective

This protocol describes a process to develop and test quality assurance (QA) measures for use within a predominantly pragmatic surgical RCT comparing minimally invasive and open techniques for oesophageal cancer (the NIHR ROMIO study). It builds on methods initiated in the ROMIO pilot RCT.

Methods and analysis

We have identified three distinct types of QA measure: (i) entry criteria for surgeons, through assessment of operative videos, (ii) standardisation of operative techniques (by establishing minimum key procedural phases) and (iii) monitoring of surgeons during the trial, using intraoperative photography to document key procedural phases and standardising the pathological assessment of specimens. The QA measures will be adapted from the pilot study and tested iteratively, and the video and photo assessment tools will be tested for reliability and validity.

Ethics and dissemination

Ethics approval was obtained (NRES Committee South West—Frenchay, 25 April 2016, ref: 16/SW/0098). Results of the QA development study will be submitted for publication in a peer-reviewed journal.

Trial registration number

ISRCTN59036820,ISRCTN10386621.
Cohort study of healthcare use, costs and diagnoses from onset to 6 months after discharge for takotsubo syndrome in Sweden
Authors: Wallström Sara , Ekman Inger , Omerovic Elmir , Ulin Kerstin , Gyllensten Hanna
Published: March 2019

Objective

Little is known about the economic impact of takotsubo syndrome (TS) for patients and the health system after initial discharge from hospital. Therefore, the aim of this study was to describe the healthcare resource use and calculate direct healthcare costs for TS, from hospitalisation to 6 months after discharge, and explore the distribution of costs between TS and other diagnoses among patients with TS.

Method, participants and setting

Cohort study investigating direct healthcare costs from hospitalisation, open specialised outpatient and primary care. Healthcare resource use during 6 months after diagnosis with TS was collected for 58 consecutive patients from the Regional Patient Register. Incidence-based direct healthcare costs, in 2015 values, were calculated using diagnosis-related group weights and unit costs from national statistics on healthcare costs.

Results

The mean length of hospital stay was 10.2 days, index 6.4 and re-admissions 3.8 days. The mean number of follow-up encounters per patient was 15.6, of which two-thirds was specialised outpatient and one-third was primary care. This resulted in an average cost of €10 360. Of this, costs of €8026 (77.5%) occurred during encounters for which at least one of the registered conditions was cardiovascular. Costs differed little according to background characteristics.

Conclusion

This study shows that patients utilise hospital, specialised outpatient and primary care after discharge for TS. Most direct healthcare costs relate to cardiac diagnoses. Patients with TS would probably benefit from a supportive follow-up programme after discharge from hospital.
Improving TB infection control in a regional hospital in the Eastern Cape, South Africa
Authors: Haeusler Ilsa Louisa , Knights Felicity , George Vishaal , Parrish Andy
Published: March 2019

This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan-Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 22% were correctly isolated and 12% had an airborne precaution sign. Post-intervention (May 2017), the compliance improved to 17%, 50% and 25%, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.
Increasing the use of home medication lists in an outpatient neurorehabilitation clinic
Authors: Guo Meiqi , Tam Alan , Dey Ayan , Fraser Beth , Podalak Margaret , Bayley Mark , Soong Christine , Lo Alexander
Published: March 2019

Medication reconciliation in ambulatory care settings helps prevent adverse drug events. Patient involvement in the process is crucial, as clinicians must verify the reported medication history with other sources such as home medication lists or brown-bagged home medications provided by patients. However, only 47.8% of brain injury and stroke adult outpatients at Toronto Rehabilitation Institute, an academic rehabilitation hospital, bring their medications/medication lists to clinic visits. In turn, missing medication information impacts the clinic by causing delays in treatment and interrupted clinic flow. This project aimed to increase the percentage of patients who bring their medications/medication lists to 80% and decrease the impact on clinic visits caused by missing medication information to 10%. This was a controlled before-after study, with the outpatient rehabilitation assessment (OPRA) clinic as the intervention and the spasticity clinic as the control. The model for improvement was used as the project framework. Process mapping, Ishikawa diagrams, driver diagrams and patient surveys generated the change ideas. Verbal reminders during confirmation phone calls, written reminders and medication list templates were implemented. Data were collected on a biweekly basis and analysed using statistical control charts. After six Plan-Do-Study-Act cycles conducted over 49 weeks, both project aims were achieved. The percentage of OPRA clinic patients who brought medications/medication lists was 81.8% and the impact on clinic visits caused by missing medication information was 9.1% of clinic visits. Special cause variation was detected on the statistical control charts. Conversely, there was no special cause variation for the spasticity clinic (the control) for either aim. Lessons learnt include the importance of prolonged data collection when implementing interventions with long lag time, and that verbal reminders may not be effective for patients with cognitive impairments. Future efforts may focus on implementing the bundle of project interventions for the spasticity clinic.