bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents
Authors: Hanlon Joseph T. , Zhao Xinhua , Naples Jennifer G. , Aspinall Sherrie L. , Perera Subashan , Nace David A. , Castle Nicholas G. , Greenspan Susan L. , Thorpe Carolyn T.
Published: February 2017

Objectives

To examine the association between CNS medication burden and serious falls in those with a recent fall history.

Design

Nested‐case control study; cases matched to four controls by age, gender, and date.

Setting

US nursing homes.

Participants

5,556 residents age ≥65 with a recent fall history admitted to a nursing home between 1/1‐9/30/2010 and followed until discharge, death, or December 31, 2010.

Measurements

Outcome was serious falls as per Medicare Part A and B ICD/CPT codes. CNS burden, from Medicare Part D data, was calculated by dividing the daily dose of each CNS agent (i.e., specific antidepressants, antiepileptic, antipsychotic, benzodiazepine and opioid receptor agonists) received during the 6 days prior to the index (outcome) date by the minimum effective geriatric daily dose and summing the results across medications.

Results

There were 367 cases and 1,468 matched controls. Those taking 3 + CNS standardized daily doses were more likely to have a serious fall than those not taking any CNS medications (Adjusted Odds Ratio 1.83; 95% confidence interval 1.35–2.48). There was no significant difference in fall risk for residents taking >0 to <3 CNS standardized daily doses compared to residents taking no CNS medications (Adjusted Odds Ratio 0.85; 95% CI 0.63–1.15).

Conclusion

CNS medication burden, approximately 3 + standardized daily doses, was associated with an increased risk of serious falls in nursing home residents with recent fall. Clinicians should be vigilant for opportunities to discontinue or decrease the doses of individual CNS medications and/or consider non‐pharmacological alternatives. Such interventions that reduce use of CNS medications in nursing homes could reduce fall rates but further research is needed to confirm this.
Unwarranted Variation in Utilization of Cesarean Birth Among Low‐Risk Childbearing Women
Authors: Jolles Diana R.
Published: January 2017

Introduction

Unwarranted variations in care are defined as differences in utilization of health care resources that cannot be explained by patient risk factors, standards of evidence‐based medicine, or patient preferences. Also known as nonmedical determinants of variation, differences in health care utilization across the United States have been well documented in the literature during the past 40 years. The purpose of the literature review is to summarize the state of the science related to the nonmedical determinants of variation in cesarean birth among low‐risk childbearing women, defined within national quality standards as nulliparous women with term, singleton pregnancies in the vertex presentation.

Methods

A literature search was performed using the electronic databases PubMed, CINAHL, Ovid MEDLINE, Google Scholar, Cochrane Database of Systematic Reviews, and ProQuest Dissertation Database. Articles published in English, with full text available, including birth in the United States after 1995, are included in the analysis. Nine studies met criteria for inclusion. Forty‐four states are represented within the data, with Arizona, California, Massachusetts, New Jersey, and New York being the subject of more than one of the publications analyzed.

Results

This literature review includes more than one million births, in at least 44 states between 1996 through 2009, revealing significant unwarranted variation in cesarean birth. Nonmedical determinants of variation, such as access to resources, hospital characteristics, payer source, and provider practice styles, are identified as independent predictors of increased cesarean utilization in more than half of the studies reviewed. In all studies reviewed, women of low medical risk demonstrate susceptibility to unwarranted variation in the use of cesarean birth.

Discussion

Continued emphasis on the specific needs of low‐risk childbearing women is necessary to decrease unwarranted variation in the use of cesarean birth in the United States. Specific attention to the costs of unwarranted variation in cesarean birth is imperative.
The efficacy study of the combination of tripeptide‐10‐citrulline and acetyl hexapeptide‐3. A prospective, randomized controlled study
Authors: Raikou Vassiliki , Varvaresou Athanasia , Panderi Irene , Papageorgiou Effie
Published: February 2017

Background

Bioactive peptides have beneficial effects on the skin.

Objective

We investigated to evaluate the effect of acetyl hexapeptide‐3 and tripeptide‐10 citrulline and the possible synergism between these two peptides.

Methods

Twenty‐four healthy volunteers were randomized to receive combination of acetyl hexapeptide‐3 with tripeptide‐10 citrulline (Group G1), tripeptide‐10 citrulline (Group, G2), acetyl hexapeptide‐3 (Group G3), or neither peptide (Group G4) for 60 days. Skin properties evaluated included skin microtopography, parameters cR2 and cR3, and transepidermal water loss (TEWL) using a skin visioscan and a tewameter, respectively.

Results

After 20 days, the measurements between G1 and G2 groups (cR2 P=.045, cR3 P=.044), G2 and G3 groups (cR2 P=.017, cR3 P=.017), G3 and G4 groups (CR2 P=.022), and G2 and G4 groups (cR3 P=.028) from baseline were significant. After 60 days, measurements between groups G1 and G3 (cR2 P=.016, cR3 P=.025), groups G2 and G3 (cR2 P=.044, cR3= P=.044), and groups G1 and G4 (cR2 P=.025) were significant. After 20 days, changes in TEWL between groups G1 and G3 (P=.03), groups G2 and G3 (P=.045), and groups G3 and G4 (P=.025) were significant. After 40 days, changes between groups G2 and G3 (P=.028) and groups G3 and G4 (P=.01) from baseline were significant.

Conclusion

Our results confirm the antiwrinkle activity of acetyl hexapeptide‐3. A significant decrease in TEWL with acetyl hexapeptide‐3 treatment is observed. We provided clinical evidence for the antiwrinkle efficacy of tripeptide‐10 citrulline and possibly TEWL. The underlying mechanism by which these two peptides can act synergistically was not clear in this study.
Markers of Oxidative Stress in Dogs with Myxomatous Mitral Valve Disease are Influenced by Sex, Neuter Status, and Serum Cholesterol Concentration
Authors: Reimann M.J. , Häggström J. , Møller J.E. , Lykkesfeldt J. , Falk T. , Olsen L.H.
Published: January 2017

Background

Cardiovascular disease has been associated with oxidative stress, which has been suggested to contribute to myocardial remodeling in human patients. Little is known about the relationship between myxomatous mitral valve disease (MMVD) and oxidative stress in dogs.

Objective

To determine whether clinical stage ofMMVDis associated with changes in the plasma concentrations of certain markers of oxidative stress in clinically healthy dogs and dogs withMMVD.

Animals

Seventy five privately owned dogs: 59 cavalier King Charles Spaniels (CKCS) with different severities ofMMVDand 16 dogs of different breeds with clinical signs of congestive heart failure (CHF) caused byMMVD.

Methods

Markers of oxidative stress including malondialdehyde (MDA), oxidized low‐density lipoprotein (oxLDL), and vitamin E (α‐tocopherol and γ‐tocopherol) were measured in plasma and their association with clinical stage ofMMVDwas assessed by regression analyses.

Results

Plasma oxLDLconcentration was significantly lower in female dogs compared with males (P= .01). Significantly higher plasma γ‐tocopherol concentrations were found in neutered (P= .003) dogs. Vitamin E (α‐tocopherol [P= .0004] and γ‐tocopherol [P= .003]) was associated with body condition score (BCS), but the association disappeared when cholesterol was included in the analyses. All markers of oxidative stress (MDA, oxLDL, and vitamin E) were positively associated with serum cholesterol concentration (P≤ .04), but none were associated with clinical stage ofMMVD.

Conclusions

In conclusion, markers of oxidative stress are associated with sex,BCS, neuter status, and cholesterol. The results cannot confirm a relationship between oxidative stress and clinical stage of the disease in dogs withMMVD.
Transformational leadership and innovative work behavior among nursing staff
Authors: Masood Mariam , Afsar Bilal
Published: February 2017

The importance of innovation within organizations has been demonstrated on numerous occasions, which has subsequently led to the identification of effective leadership as a potential catalyst. Most of us would acknowledge that effective leadership plays a pivotal role to engender innovativeness among nursing staff. Although research has identified some leadership styles to foster a nurse's innovative work behavior, a comprehensive model explaining the effect of transformational leadership on nurses’ innovative work behavior is still unclear. This research built and tested a theoretical model linking transformational leadership and innovative work behavior via several intervening variables. Data were collected from 587 nurses and 164 doctors (nursing supervisors) through structured questionnaires from public sector hospitals in Pakistan. Results of the study indicated that, as anticipated, transformational leadership positively affected psychological empowerment of nurses, which in turn influenced both intrinsic motivation and knowledge sharing behavior. These latter two variables then had a positive influence on innovative work behavior. Empowerment role identity moderated the link between transformational leadership and psychological empowerment, whereas willingness to rely on leader (reliance‐based trust) and willingness to share sensitive information with leader (disclosure‐based trust) moderated the connection between knowledge sharing behavior and innovative work behavior. These results imply that transformational leadership through psychological empowerment, knowledge sharing, and intrinsic motivation fosters nurse's innovative work behavior. The results also show that the relationship between transformational leadership and innovative work behavior is stronger among nurses who frequently share their knowledge about best practices and mistakes with co‐workers.
Photoprotection in a monophyletic branch of chlorophyte algae is independent of energy‐dependent quenching (qE)
Authors: Christa Gregor , Cruz Sónia , Jahns Peter , de Vries Jan , Cartaxana Paulo , Esteves Ana Cristina , Serôdio João , Gould Sven B.
Published: February 2017

Phototrophic organisms need to ensure high photosynthetic performance whilst suppressing reactive oxygen species (ROS)‐induced stress occurring under excess light conditions. The xanthophyll cycle (XC), related to the high‐energy quenching component (qE) of the nonphotochemical quenching (NPQ) of excitation energy, is considered to be an obligatory component of photoprotective mechanisms.

The pigment composition of at least one representative of each major clade of Ulvophyceae (Chlorophyta) was investigated. We searched for a light‐dependent conversion of pigments and investigated the NPQ capacity with regard to the contribution of XC and the qE component when grown under different light conditions.

A XC was found to be absent in a monophyletic group of Ulvophyceae, the Bryopsidales, when cultivated under low light, but was triggered in one of the 10 investigated bryopsidalean species, Caulerpa cf. taxifolia, when cultivated under high light. Although Bryopsidales accumulate zeaxanthin (Zea) under high‐light (HL) conditions, NPQ formation is independent of a XC and not related to qE.

qE‐ and XC‐independent NPQ in the Bryopsidales contradicts the common perception regarding its ubiquitous occurrence in Chloroplastida. Zea accumulation in HL‐acclimated Bryopsidales most probably represents a remnant of a functional XC. The existence of a monophyletic algal taxon that lacks qE highlights the need for broad biodiversity studies on photoprotective mechanisms.
Ciliated muconodular papillary tumor of the lung harboring ALK gene rearrangement: Case report and review of the literature
Authors: Jin Yan , Shen Xuxia , Shen Lei , Sun Yihua , Chen Haiquan , Li Yuan
Published: February 2017

Ciliated muconodular papillary tumor (CMPT) of the lung is an extremely rare peripheral tumor of the lung. The pathogenesis of CMPT is still unknown, and its nature as a benign tumor or reactive process is still open to discussion. Recent studies have identified BRAF, EGFR and AKT1 mutations in CMPT, which would support a true neoplastic process. Here for the first time, we report a case of morphologically typical CMPT harboring ALK gene rearrangement to further provide convincing evidence that CMPT is a neoplastic process rather than a reactive lesion. The patient was a 59‐year‐old woman, characterized by a circumscribed tubulopapillary tumor consisting of ciliated columnar cells, mucous cells, and basal cells, accompanied with peripheral abundant extracellular mucin. The tubulopapillary architecture with abundant extracellular mucin is mimicking adenocarcinoma. The tumor cells were immunoreactive for cytokeratin 7, thyroid transcription factor‐1, whereas p40 and p63 highlighted the presence of basal cells. The ALK gene rearrangement was detected using fluorescence in situ hybridization and Ventana immunohistochemistry platform. To our knowledge, this is the first study to confirm CMPT harboring ALK gene rearrangement.
Product Recall Decisions in Medical Device Supply Chains: A Big Data Analytic Approach to Evaluating Judgment Bias
Authors: Mukherjee Ujjal Kumar , Sinha Kingshuk K.
Published: January 2017

This study investigates judgment bias (under‐reaction or over‐reaction) in product recall decisions by firms when they respond to adverse event reports generated by users of their products. We develop an integrative theoretical framework for identifying the sources of judgment bias in product recall decisions. We analyze user‐generated reports (big and unstructured data) on adverse events related to medical devices, using a combination of econometric and predictive analytic methods. We find that (i) noisy signals in user feedback, that is, high noise‐to‐signal ratio, are associated with under‐reaction likelihood; and (ii) user feedback related to adverse events characterized by high severity is associated with high over‐reaction likelihood. We also identify conditions related to the situated context of managers that are associated with under‐reaction or over‐reaction likelihood. The findings of this study are consequential for firms and government regulatory agencies, in that they shed light on the sources of judgment bias in recall decisions, thereby ensuring that such decisions are made correctly and in a timely manner. Our findings also contribute toward improving the post‐launch market surveillance of products (e.g., medical devices) by making it more evidence‐based and predictive.
Mitigating the U.S. Drug Shortages Through Pareto‐Improving Contracts
Authors: Jia Justin , Zhao Hui
Published: January 2017

Drug shortages have been a major challenge facing the US pharmaceutical industry and government in recent years. Although the problem has drawn tremendous attention from the government and media, limited academic research has been devoted to this problem, and few solutions have been proposed based on rigorous research. This study addresses the drug shortage problem from a supply chain perspective, a key aspect missing in the literature, and proposes to mitigate shortages through drug purchase contracts. By modeling the drug supply chain, we capture the objectives of various supply chain parties, and investigate Pareto‐improving contracts that mitigate drug shortages, improve drug manufacturer's and group purchasing organization (GPO)'s profits, and cut government spending and healthcare providers’ costs. We explore structural properties of key supply chain decisions and the Pareto‐improving contracts, and conduct scenario analysis with realistic industry data to evaluate shortage mitigation solutions. Our analysis shows that increasing drug prices only, a solution advocated by many, is not very effective in shortage mitigation. Price increases must be paired with strengthened failure‐to‐supply clauses (called the IPS approach) to achieve consistent and significant shortage reduction as well as Pareto improvement. Across all scenarios tested, a 30% price increase under IPS can lead to a minimum, average, and maximum shortage reduction of 25%, 53%, and 70%, respectively. Our analysis also shows the impacts of IPS on different parties in the supply chain and the impacts of various model parameters on shortage mitigation. The IPS approach rewards reliability of drug supply, which is in line with the FDA's strategic plan to reward quality, but is easier to achieve in this regulation‐based industry. Interactions with the government and industry practitioners indicate that IPS also challenges the current mindset in pharmaceutical contracting.
Suicide Exposure in the Population: Perceptions of Impact and Closeness
Authors: Cerel Julie , Maple Myfanwy , van de Venne Judy , Brown Melissa , Moore Melinda , Flaherty Chris
Published: February 2017

Recent studies of people exposed to suicide point to a continuum of effects moderated by a perception of closeness to the deceased. We investigated the importance of perception of impact of the death on mental health outcomes of those exposed to suicide. Female sex, younger age, and multiple exposures to suicide were associated with greater risk for poorer outcomes. Suicide exposed with high impact was more likely to have depression, anxiety, posttraumatic stress disorder, prolonged grief, and suicide ideation. Findings can help focus postvention resources for suicide‐exposed individuals.
First molecular epidemiology of Entamoeba histolytica, E. dispar and E. moshkovskii infections in Yemen: different species‐specific associated risk factors
Authors: Al‐Areeqi Mona A. , Sady Hany , Al‐Mekhlafi Hesham M. , Anuar Tengku Shahrul , Al‐Adhroey Abdulelah H. , Atroosh Wahib M. , Dawaki Salwa , Elyana Fatin Nur , Nasr Nabil A. , Ithoi Init , Lau Yee‐Ling , Surin Johari
Published: February 2017

Objectives

To investigate the molecular epidemiology of Entamoeba histolytica, E. dispar and E. moshkovskii infections among rural communities in Yemen.

Methods

In a community‐based study, faecal samples were collected from 605 participants and examined by wet mount, formalin‐ether sedimentation, trichrome staining and nested multiplex PCR techniques. Demographic, socio‐economic and environmental information was collected using a pre‐tested questionnaire.

Results

Overall, 324 (53.6%) of the samples were positive for Entamoeba cysts and/or trophozoites by microscopic examination. Molecular analysis revealed that 20.2%, 15.7% and 18.2% of the samples were positive for E. histolytica, E. dispar and E. moshkovskii, respectively. Multivariate analysis showed different sets of species‐specific risk factors among these communities. Educational level was identified as the significant risk factor for E. histolytica; age and gender were the significant risk factors for E. moshkovskii; and sources of drinking water and consumption of unwashed vegetables were the significant risk factors for E. dispar. Moreover, living in coastal/foothill areas and presence of other infected family members were risk factors for both E. histolytica and E. moshkovskii infections.

Conclusion

The study reveals that Entamoeba spp. infection is highly prevalent among rural communities in Yemen, with E. histolytica, E. dispar and E. moshkovskii differentiated for the first time. Identifying and treating infected family members, providing health education pertinent to good personal and food hygiene practices and providing clean drinking water should be considered in developing a strategy to control intestinal parasitic infections in these communities, particularly in the coastal/foothill areas of the country.
Dynamic Neural Network-Based Output Feedback Tracking Control for Uncertain Nonlinear Systems
Authors: Dinh Huyen T. , Bhasin S. , Kamalapurkar R. , Dixon W. E.
Published: February 2017

A dynamic neural network (DNN) observer-based output feedback controller for uncertain nonlinear systems with bounded disturbances is developed. The DNN-based observer works in conjunction with a dynamic filter for state estimation using only output measurements during online operation. A sliding mode term is included in the DNN structure to robustly account for exogenous disturbances and reconstruction errors. Weight update laws for the DNN, based on estimation errors, tracking errors, and the filter output are developed, which guarantee asymptotic regulation of the state estimation error. A combination of a DNN feedforward term, along with the estimated state feedback and sliding mode terms yield an asymptotic tracking result. The developed output feedback (OFB) method yields asymptotic tracking and asymptotic estimation of unmeasurable states for a class of uncertain nonlinear systems with bounded disturbances. A two-link robot manipulator is used to investigate the performance of the proposed control approach.
Effect of Light Water Reactor Water Environments on the Fatigue Life of Reactor Materials
Authors: Chopra O. K. , Stevens G. L. , Tregoning R. , Rao A. S.
Published: February 2017

The American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code (Code) provides rules for the design of Class 1 components of nuclear power plants. However, the Code design curves do not address the effects of light water reactor (LWR) water environments. Existing fatigue strain-versus-life (ε–N) data illustrate significant effects of LWR water environments on the fatigue resistance of pressure vessel and piping steels. Extensive studies have been conducted at Argonne National Laboratory (Argonne) and elsewhere to investigate the effects of LWR environments on the fatigue life. This article summarizes the results of these studies. The existing fatigue ε–N data were evaluated to identify the various material, environmental, and loading conditions that influence the fatigue crack initiation; a methodology for estimating fatigue lives as a function of these parameters was developed. The effects were incorporated into the ASME Code Section III fatigue evaluations in terms of an environmental correction factor, Fen, which is the ratio of fatigue life in air at room temperature to the life in the LWR water environment at reactor operating temperatures. Available fatigue data were used to develop fatigue design curves for carbon and low-alloy steels, austenitic stainless steels (SSs), and nickel–chromium–iron (Ni–Cr–Fe) alloys and their weld metals. A review of the Code Section III fatigue adjustment factors of 2 and 20 is also presented, and the possible conservatism inherent in the choice is evaluated. A brief description of potential effects of neutron irradiation on fatigue crack initiation is presented.
Coupling organelle inheritance with mitosis to balance growth and differentiation
Authors: Asare Amma , Levorse John , Fuchs Elaine
Published: February 2017

Peroxisome inheritance and differentiation

For normal tissue structure and function, cells exert strict control over growth versus differentiation. Poor wound healing and aging can result from too little proliferation. Conversely, the development of cancer can involve excessive cell growth. Asare
et al.
looked for regulators that balance proliferation and differentiation in the epidermis (see the Perspective by Gruneberg and Barr). They observed differences in the transcript profile of epidermal progenitors, their differentiating progeny, and epidermal cancers. Epidermal progenitors that were deficient in the peroxisome-associate protein Pex11b did not segregate peroxisomes properly among dividing cells. This led to a delay in mitosis that perturbed polarized divisions. These events skewed daughter cell fate and resulted in a defective skin barrier. Thus, peroxisome inheritance appears to play a role in normal mitosis and cell differentiation.

Science
, this issue
10.1126/science.aah4701
; see also p.
459
Bacillus subtilis
SMC complexes juxtapose chromosome arms as they travel from origin to terminus
Authors: Wang Xindan , Brandão Hugo B. , Le Tung B. K. , Laub Michael T. , Rudner David Z.
Published: February 2017

Tethering DNA for packing purposes

Condensin protein complexes are critical for chromosome segregation and compaction. They form ring-shaped structures that encircle and topologically constrain DNA strands. Wang
et al.
show that
Bacillus subtilis
condensin complexes hold the two arms of the circular chromosome together (see the Perspective by Sherratt). The complexes seem to do this by encircling individual DNA duplexes and then tethering the two duplexes together by “handcuffing.” The complexes actively travel along the DNA and function to enlarge DNA loops processively, leading to chromosome compaction.

Science
, this issue p.
524
; see also p.
460
Improving election prediction internationally
Authors: Kennedy Ryan , Wojcik Stefan , Lazer David
Published: February 2017

Using global data for election predictions

Assumptions underlying election result predictions have been questioned recently. Kennedy
et al.
assessed more than 650 executive office elections in over 85 countries and performed two live forecasting experiments. They analyzed a variety of potential predictors theorized to be of importance, ranging from economic performance to polling data. Elections were about 80 to 90% predictable, despite uncertainties with available data. Polling data were very important to successful prediction, although it was necessary to correct for systematic biases. Unexpectedly, economic indicators were only weakly predictive. As data sources improve and grow, predictive power is expected to increase.

Science
, this issue p.
515
Predicting human behavior: The next frontiers
Authors: Subrahmanian V. S. , Kumar Srijan
Published: February 2017

Machine learning has provided researchers with new tools for understanding human behavior. In this article, we briefly describe some successes in predicting behaviors and describe the challenges over the next few years.
Four sexually transmitted infections (STIs) in Belgian general practice: first results (2013–2014) of a nationwide continuing surveillance study
Authors: Boffin N , Moreels S , Deblonde J , Van Casteren V
Published: January 2017

Objectives

To describe and explore data from the surveillance of chlamydia, syphilis, gonorrhoea and genital warts by the Belgian Network of Sentinel General Practices (SGP) over the first 2 years (2013 and 2014) and to estimate the incidence of these 4 sexually transmitted infections (STIs). A special focus is put on data quality.

Design

Retrospective observational study.

Setting

General practices from the nationwide representative SGP network.

Outcome measures

Agreement between data distributions by year, agreement between SGP-based incidence and incidence based on mandatory notification, missingness of patient age or gender and incompleteness of sexual risk history of patients.

Results

306 new STI episodes were reported from 298 patients, corresponding with an episode-based incidence of 91.9/100 000 (95% CI 81.9 to 102.8) general practice patients, with almost half of it due to chlamydia. The incidence of chlamydia in men was significantly higher in 2014 than in 2013. Population characteristics were similarly distributed in 2013 and 2014. The SGP-based incidence of gonorrhoea and syphilis in Flanders were in agreement with the incidence based on mandatory notification of cases. Patient age or gender was missing from 35 episodes (11.4%). Independent determinants of missingness of patient age or gender were the Flemish region (OR 3.46; 95% CI 1.02 to 11.73) and genital warts infection (OR 2.23; 95% CI 1.07 to 4.63). An incomplete sexual risk history was reported for 54.6% STI episodes. The odds for an incomplete sexual history were higher for older patients (OR 1.72; 95% CI 1.06 to 2.76) and for patients infected with syphilis, gonorrhoea or co-infection(s) (OR 1.71; 95% CI 1.03 to 2.83).

Conclusions

Incompleteness of reports about patients with STI sexual risk histories is important from the perspective of quality of data and of quality of care. Together with the low rates of both HIV testing and discussion of partner notification, this suggests that a general practice guideline is needed.
Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK
Authors: Marciniak Anna , Glover Keli , Sharma Rajan
Published: January 2017

Purpose

The aim of this study was to evaluate the proportion of suspected heart failure patients with significant valvular heart disease. Early diagnosis of valve disease is essential as delay can limit treatment and negatively affect prognosis for undiagnosed patients. The prevalence of unsuspected valve disease in the community is uncertain.

Participants

We prospectively evaluated 79 043 patients, between 2001 and 2011, who were referred to a community open access echocardiography service for suspected heart failure. All patients underwent a standard transthoracic echocardiogram according to British Society of Echocardiography guidelines.

Findings to date

Of the total number, 29 682 patients (37.5%) were diagnosed with mild valve disease, 8983 patients (11.3%) had moderate valve disease and 2134 (2.7%) had severe valve disease. Of the total number of patients scanned, the prevalence of aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation was 10%, 8.4%, 1%, and 12.5% respectively. 18% had tricuspid regurgitation. 5% had disease involving one or more valves.

Conclusions

Of patients with suspected heart failure in the primary care setting, a significant proportion have important valvular heart disease. These patients are at high risk of future cardiac events and will require onward referral for further evaluation. We recommend that readily available community echocardiography services should be provided for general practitioners as this will result in early detection of valve disease.
Methodology used in comparative studies assessing programmes of transition from paediatrics to adult care programmes: a systematic review
Authors: Le Roux E , Mellerio H , Guilmin-Crépon S , Gottot S , Jacquin P , Boulkedid R , Alberti C
Published: January 2017

Objective

To explore the methodologies employed in studies assessing transition of care interventions, with the aim of defining goals for the improvement of future studies.

Design

Systematic review of comparative studies assessing transition to adult care interventions for young people with chronic conditions.

Data sources

MEDLINE, EMBASE, ClinicalTrial.gov.

Eligibility criteria for selecting studies

2 reviewers screened comparative studies with experimental and quasi-experimental designs, published or registered before July 2015. Eligible studies evaluate transition interventions at least in part after transfer to adult care of young people with chronic conditions with at least one outcome assessed quantitatively.

Results

39 studies were reviewed, 26/39 (67%) published their final results and 13/39 (33%) were in progress. In 9 studies (9/39, 23%) comparisons were made between preintervention and postintervention in a single group. Randomised control groups were used in 9/39 (23%) studies. 2 (2/39, 5%) reported blinding strategies. Use of validated questionnaires was reported in 28% (11/39) of studies. In terms of reporting in published studies 15/26 (58%) did not report age at transfer, and 6/26 (23%) did not report the time of collection of each outcome.

Conclusions

Few evaluative studies exist and their level of methodological quality is variable. The complexity of interventions, multiplicity of outcomes, difficulty of blinding and the small groups of patients have consequences on concluding on the effectiveness of interventions. The evaluation of the transition interventions requires an appropriate and common methodology which will provide access to a better level of evidence. We identified areas for improvement in terms of randomisation, recruitment and external validity, blinding, measurement validity, standardised assessment and reporting. Improvements will increase our capacity to determine effective interventions for transition care.
Cost-effectiveness research in cancer therapy: a systematic review of literature trends, methods and the influence of funding
Authors: Al-Badriyeh Daoud , Alameri Marwah , Al-Okka Randa
Published: January 2017

Objective

To perform a first-time analysis of the cost-effectiveness (CE) literature on chemotherapies, of all types, in cancer, in terms of trends and change over time, including the influence of industry funding.

Design

Systematic review.

Setting

A wide range of cancer-related research settings within healthcare, including health systems, hospitals and medical centres.

Participants

All literature comparative CE research of drug-based cancer therapies in the period 1986 to 2015.

Primary and secondary outcome measures

Primary outcomes are the literature trends in relation to journal subject category, authorship, research design, data sources, funds and consultation involvement. An additional outcome measure is the association between industry funding and study outcomes.

Analysis

Descriptive statistics and the χ2, Fisher exact or Somer's D tests were used to perform non-parametric statistics, with a p value of <0.05 as the statistical significance measure.

Results

Total 574 publications were analysed. The drug-related CE literature expands over time, with increased publishing in the healthcare sciences and services journal subject category (p<0.001). The retrospective data collection in studies increased over time (p<0.001). The usage of prospective data, however, has been decreasing (p<0.001) in relation to randomised clinical trials (RCTs), but is unchanging for non-RCT studies. The industry-sponsored CE studies have especially been increasing (p<0.001), in contrast to those sponsored by other sources. While paid consultation involvement grew throughout the years, the declaration of funding for this is relatively limited. Importantly, there is evidence that industry funding is associated with favourable result to the sponsor (p<0.001).

Conclusions

This analysis demonstrates clear trends in how the CE cancer research is presented to the practicing community, including in relation to journals, study designs, authorship and consultation, together with increased financial sponsorship by pharmaceutical industries, which may be more influencing study outcomes than other funding sources.
Computerised cognitive–behavioural therapy for depression in adolescents: feasibility results and 4-month outcomes of a UK randomised controlled trial
Authors: Wright Barry , Tindall Lucy , Littlewood Elizabeth , Allgar Victoria , Abeles Paul , Trépel Dominic , Ali Shehzad
Published: January 2017

Objectives

Computer-administered cognitive–behavioural therapy (CCBT) may be a promising treatment for adolescents with depression, particularly due to its increased availability and accessibility. The feasibility of delivering a randomised controlled trial (RCT) comparing a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression was evaluated.

Design

Single centre RCT feasibility study.

Setting

The trial was run within community and clinical settings in York, UK.

Participants

Adolescents (aged 12–18) with low mood/depression were assessed for eligibility, 91 of whom met the inclusion criteria and were consented and randomised to Stressbusters (n=45) or websites (n=46) using remote computerised single allocation. Those with comorbid physical illness were included but those with psychosis, active suicidality or postnatal depression were not.

Interventions

An eight-session CCBT program (Stressbusters) designed for use with adolescents with low mood/depression was compared with an attention control (accessing low mood self-help websites).

Primary and secondary outcome measures

Participants completed mood and quality of life measures and a service Use Questionnaire throughout completion of the trial and 4 months post intervention. Measures included the Beck Depression Inventory (BDI) (primary outcome measure), Mood and Feelings Questionnaire (MFQ), Spence Children's Anxiety Scale (SCAS), the EuroQol five dimensions questionnaire (youth) (EQ-5D-Y) and Health Utility Index Mark 2 (HUI-2). Changes in self-reported measures and completion rates were assessed by treatment group.

Results

From baseline to 4 months post intervention, BDI scores and MFQ scores decreased for the Stressbusters group but increased in the website group. Quality of life, as measured by the EQ-5D-Y, increased for both groups while costs at 4 months were similar to baseline. Good feasibility outcomes were found, suggesting the trial process to be feasible and acceptable for adolescents with depression.

Conclusions

With modifications, a fully powered RCT is achievable to investigate a promising treatment for adolescent depression in a climate where child mental health service resources are limited.

Trial registration number

ISRCTN31219579.
Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study
Authors: Berg Siv Hilde , Rørtveit Kristine , Walby Fredrik A , Aase Karina
Published: January 2017

Introduction

Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved.

Methods

This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice.

Ethics and dissemination

This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients.
Evaluation of IL-12RB1, IL-12B, CXCR-3 and IL-17a expression in cases affected by a non-healing form of cutaneous leishmaniasis: an observational study design
Authors: Moafi Mohammad , Rezvan Hossein , Sherkat Roya , Taleban Roya , Asilian Ali , Zarkesh Esfahani Seyed Hamid , Nilforoushzadeh Mohammad Ali , Jaffary Fariba , Feizi Awat
Published: January 2017

Introduction

Seldom cutaneous leishmaniasis (CL) may present as a lasting and active lesion(s), known as a non-healing form of CL (NHCL). Non-functional type 1 T helper (Th1) cells are assumed the most important factor in the outcome of the disease. The present study aims to assess some molecular defects that potentially contribute to Th1 impairment in NHCL.

Methods and analysis

This prospective observational study will be implemented among five groups. The first and second groups comprise patients afflicted with non-healing and healing forms of CL, respectively. The third group consists of those recovered participants who have scars as a result of CL. Those participants who have never lived or travelled to endemic areas of leishmaniasis will comprise the fourth group. The fifth group comprises participants living in hyperendemic areas for leishmaniasis, although none of them have been afflicted by CL. The aim is to recruit 10 NHCL cases and 30 participants in each of the other groups. A leishmanin skin test (LST) will be performed to assess in vivo immunity against theLeishmaniainfection. The cytokine profile (interleukin (IL)-12p70, interferon (IFN)-γ, C-X-C motif chemokine ligand (CXCL)-11 and IL-17a) of the isolated peripheral blood mononuclear cells (PBMCs) will be evaluated through ELISA. Real-time PCR will determine the C-X-C motif chemokine receptor (CXCR)-3 and IL-17a gene expression and expression of IL-12Rβ1 will be assessed by flow cytometry. Furthermore, IL-12B and IL-12RB1 mutation analysis will be performed.

Discussion

It is anticipated that the outcome of the current study will identify IL-12B and IL-12RB1 mutations, which lead to persistent lesions of CL. Furthermore, our expected results will reveal an association between NHCL and pro-inflammatory cytokines (IL-12p70, IFN-γ IL-17a and CXCL-11), as well as CXCR-3 expression.

Ethics and dissemination

This study has been approved by a local ethical committee. The final results will be disseminated through peer-reviewed journals and scientific conferences.
Functional outcome after Mason II–III radial head and neck fractures: study protocol for a systematic review in accordance with the PRISMA statement
Authors: Hagelberg Mårten , Thune Alexandra , Krupic Ferid , Salomonsson Björn , Sköldenberg Olof
Published: January 2017

Introduction

Fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately one-third of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no absolute consensus regarding optimal treatment for different fracture types. The aim of this protocol is to present the method that will be used to collect, describe and analyse the current evidence regarding the treatment of Mason II–III radial head and neck fractures.

Method and analysis

We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines statement. We will search a number of databases with a predefined search strategy to collect both randomised and non-randomised studies. The articles will be summarised with descriptive statistics. If applicable a meta-analysis will be conducted.

Ethics and dissemination

Ethical approval is not required since this is a protocol for a systematic review and no primary data will be collected. The authors will publish findings from this review in a peer-reviewed scientific journal.

Trial registration number

CRD42016037627.
Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test
Authors: Ohtera Shosuke , Kanazawa Natsuko , Ozasa Neiko , Ueshima Kenji , Nakayama Takeo
Published: January 2017

Objectives

Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice.

Design and setting

This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan.

Participants

10 professionals in cardiac rehabilitation for the consensus panel.

Results

In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46–100%). ‘Communication with the doctor who referred the patient to cardiac rehabilitation’ and ‘continuous participation in cardiac rehabilitation’ had low performance (32% and 38%, respectively).

Conclusions

A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation.
Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol
Authors: Mansur Nacime Salomão Barbachan , Faloppa Flávio , Belloti João Carlos , Ingham Sheila J McNeill , Matsunaga Fabio Teruo , Santos Paulo Roberto Dias dos , Santos Bruno Schiefer dos , Carrazzone Oreste Lemos , Peixoto Gabriel , Aoyama Bruno Takeshi , Tamaoki Marcel Jun Sugawara
Published: January 2017

Background

There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illness; however, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested.

Hypothesis

Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function.

Design

Double blind, placebo-controlled, parallel groups, randomised clinical trial.

Materials and methods

93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24 weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the χ2test and the analysis of variance for statistical analyses.

Discussion

This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course.

Ethics and dissemination

The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481).

Trial registration number

8094833648737701 (NCT02757664); Pre-results.