bluuebunny/crossref_metadata_2025 huggingface dataset:
Моделирование температурного отклика системы чугун-бетон при активном тепловом неразрушающем контроле
Authors: Желнин Максим Сергеевич , Zhelnin Maksim Sergeevich , Плехов Олег Анатольевич , Plekhov O A , Левин Лев Юрьевич , Levin Lev Yur'evich
Published: April 2019

Статья посвящена математическому моделированию теплофизического эксперимента диагностики затюбингового пространства вертикальной тюбинговой крепи методом синхронной оптической термографии. Представлена постановка и численное решение двумерной краевой задачи нестационарного теплообмена, включающего в себя перенос тепла за счет теплопроводности, естественной конвекции и излучения. Обнаружение дефекта в затюбинговом пространстве осуществляется на основе анализа распределений фазовых характеристик колебаний температуры на доступной для наблюдений границе тюбинга, вычисленных методом цифровой синхронной корреляции. С целью оптимизации процесса активного теплового неразрушающего контроля проведено исследование влияния частоты нагрева, продолжительности нагрева и шума на распределение фазовых характеристик. Для математической обработки зашумленных данных предложен алгоритм, основанный на использовании эталонного распределения температуры на границе тюбинга с бездефектным затюбинговым пространством и включающий в себя фильтр Калмана, процедуру сглаживания Rauch-Tung-Striebel и метод сглаживающих сплайнов с критериальным выбором параметра сглаживания. Эффективность представленного подхода иллюстрируется результатами вычислительных экспериментов.
Процедура апскейлинга для моделирования скважин с трещинами гидроразрыва пласта
Authors: Киреев Тимур Фаритович , Kireev Timur Faritovich , Булгакова Гузель Талгатовна , Bulgakova Guzel Talgatovna
Published: April 2019

Одной из важных задач в пластовом моделировании является корректный учет влияния трещин гидравлического разрыва пласта (ГРП) на работу скважин. Метод апскейлинга позволяет эффективно вычислять приток к скважине с трещиной ГРП в расчетах на грубой сетке. В работе предложена процедура апскейлинга проводимости около трещины ГРП на неструктурированной сетке Вороного. Продемонстрировано преимущество данного подхода перед классическим методом моделирования трещин EDFM.
Fifteen-minute consultation: The EATERS method for the diagnosis of food allergies
Authors: Erlewyn-Lajeunesse Mich , Weir Thomas , Brown Lindsay , Howells Helen , Rowley Jennie , Grainger-Allen Emma , Powell Charlie
Published: April 2019

The EATERS mnemonic is a novel method for taking an allergy focused clinical history. It provides a degree of certainty for diagnosing food allergy and can be used in both IgE and non IgE mediated reactions. EATERS will allow health care professionals to use their existing clinical skills to interpret the history of an allergic reaction, and by doing so will help to make sense of allergy test results.
Successful liver transplantation in common variable immune deficiency with reversal of hepatopulmonary syndrome
Authors: Apostolov Ross , Sinclair Marie , Lokan Julie , Angus Peter
Published: April 2019

Common variable immune deficiency (CVID) is a primary immunodeficiency disorder that is associated with abnormal liver function tests, however advanced liver disease is uncommon. Hepatopulmonary syndrome (HPS) is a rare but debilitating complication of CVID-associated liver disease. We report a case of CVID complicated by HPS that was successfully treated with orthotopic liver transplant, with the patient recovering to normal hepatic function and successfully weaning off domiciliary oxygen post-transplantation.
Empyema thoracis secondary to community-acquired Panton-Valentine leukocidin (PVL) methicillin-resistantStaphylococcus aureus(MRSA) infection
Authors: Piracha Shahbaz , Ahmed Syeda Saba Muneer , Mohd Afzal Samira , Ganaie Muhammad Badar
Published: April 2019

We report a case of a previously fit middle-aged man presenting to the outpatient setting with unilateral pleural effusion, with minimal symptoms. On subsequent investigations, he was diagnosed with empyema thoracis secondary to Panton-Valentine leukocidin (PVL)-toxin positive community-acquired methicillin-resistantStaphylococcus aureus(MRSA). The patient was treated with prolonged antibiotics and pleural drainage, and he remained haemodynamically stable throughout hospital admission. PVL is a cytolytic exotoxin produced by some strains ofS. aureus. Such strains often cause recurrent skin and soft tissue infections, usually in previously fit and healthy individuals. Less commonly, invasive infections occur; these carry a high mortality rate if associated with necrotising pneumonia or septic shock. PVL genes are present in approximately 2% of clinical isolates ofS. aureusin the UK. PVL-producing MRSA infections are on the rise and present significant clinical and public health challenges.
Successful clozapine rechallenge in a patient with suspected drug induced lupus
Authors: Pathak Suraj , Cherry Scott , Samad Samreen , Aftab Ambreen
Published: April 2019

Clozapine is the most effective treatment for patients with refractory schizophrenia. Clozapine is also associated with serious and potentially lethal side effects including drug induced lupus (DIL). There have been four previous published case reports describing clozapine inducing a lupus-like syndrome including one previous case where a clozapine rechallenge was attempted without success. This case report describes a successful clozapine rechallenge in a patient with suspected DIL.
Cervical screening and risk of adenosquamous and rare histological types of invasive cervical carcinoma: population based nested case-control study
Authors: Lei Jiayao , Andrae Bengt , Ploner Alexander , Lagheden Camilla , Eklund Carina , Nordqvist Kleppe Sara , Wang Jiangrong , Fang Fang , Dillner Joakim , Elfström K Miriam , Sparén Pär
Published: April 2019

Objectives

To examine the association of cervical cytology screening with the risk of adenosquamous cell carcinoma (ASC) and rare histological types of invasive cervical carcinoma (RICC), using comprehensive registry data, and to assess tumour human papillomavirus status of ASC and RICC.

Design

Nationwide, population based, nested case-control study.

Setting

Sweden.

Participants

All cases of invasive cervical carcinoma in Sweden during 2002-11 (4254 confirmed cases after clinical and histopathological review). 338 cases were neither squamous cell carcinoma nor adenocarcinoma, including 164 cases of ASC and 174 cases of RICC (glassy cell carcinoma, clear cell carcinoma, small cell carcinoma, neuroendocrine cell carcinoma, large cell carcinoma, and undifferentiated carcinoma). 30 birth year matched controls from the general Swedish population were matched to each case by applying incidence density sampling.

Main outcome measures

Conditional logistic regression was used to calculate odds ratios, interpreted as incidence rate ratios, for risk of ASC and RICC in relation to screening status and screening history, adjusted for education. Human papillomavirus distribution of ASC and RICC was based on available archival tumour tissues from most Swedish pathology biobanks.

Results

Women with two screening tests in the previous two recommended screening intervals had a lower risk of ASC (incidence rate ratio 0.22, 95% confidence interval 0.14 to 0.34) and RICC (0.34, 0.21 to 0.55), compared with women without any test. High risk human papillomavirus was detected in 148/211 (70%) cases with valid human papillomavirus results from tumour tissues. The risk reduction among women with tumours that were positive (incidence rate ratio 0.28, 0.18 to 0.46) and negative (0.27, 0.13 to 0.59) for high risk human papillomavirus was similar, compared with women who did not attend any test.

Conclusions

Cervical screening is associated with reduced risk of ASC and RICC, and most ASC and RICC are positive for high risk human papillomavirus. This evidence provides a benchmark for evaluating future cervical screening strategies.
Short-term impact of introducing a soft opt-out organ donation system in Wales: before and after study
Authors: Noyes Jane , McLaughlin Leah , Morgan Karen , Walton Philip , Curtis Rebecca , Madden Susanna , Roberts Abigail , Stephens Michael
Published: April 2019

Objectives

To determine the short-term impact of a soft opt-out organ donation system on consent rates and donor numbers.

Design

Before and after observational study using bespoke routinely collected data.

Setting

National Health Service Blood and Transplant.

Participants

205 potential organ donor cases in Wales.

Interventions

The Act and implementation strategy.

Primary and secondary outcomes

Consent rates at 18 months post implementation compared with 3 previous years, and organ donor numbers 21 months before and after implementation. Changes in organ donor register activity post implementation for 18 months.

Results

The consent rate for all modes of consent was 61.0% (125/205), showing a recovery from the dip to 45.8% in 2014/2015. 22.4% (46/205) were deemed consented donors: consent rate 60.8% (28/46). Compared with the 3 years before the switch there was a significant difference in Welsh consent rates (χ2p value=0.009). Over the same time period, rest of the UK consent rates also significantly increased from 58.6% (5256/8969) to 63.1% (2913/4614) (χ2p value<0.0001), therefore the Wales increase cannot be attributed to the Welsh legislation change. Deceased donors did not increase: 101 compared with 104. Organ donation registration increased from 34% to 38% with 6% registering to opt-out.

Conclusion

This is the first rigorous initial evaluation with bespoke data collected on all cases. The longer-term impact on consent rates and donor numbers is unclear. Concerns about a potential backlash and mass opting out were not realised. The move to a soft opt-out system has not resulted in a step change in organ donation behaviour, but can be seen as the first step of a longer journey. Policymakers should not assume that soft opt-out systems by themselves simply need more time to have a meaningful effect. Ongoing interventions to further enhance implementation and the public’s understanding of organ donation are needed to reach the 2020 target of 80% consent rates. Further longitudinal monitoring is required.
Day of the week to tweet: a randomised controlled trial
Authors: Jayaram Mahesh , Adams Clive E , Friedel Johannes S , McClenaghan Eimear , Montgomery Alan A , Välimäki Maritta , Schmidt Lena , Xia Jun , Zhao Sai
Published: April 2019

Objective

To assess the effects of using health social media on different days of the working week on web activity.

Design

Individually randomised controlled parallel group superiority trial.

Setting

Twitter and Weibo.

Participants

194 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. There were no human participants.

Interventions

Three randomly ordered slightly different messages (maximum of 140 characters), each containing a short URL to the freely accessible summary page, were sent on specific times on a single day. Each of these messages sent on Tuesday, Wednesday, Thursday and Friday was compared with the one sent on Monday.

Outcome

The primary outcome was visits to the relevant Cochrane summary web page at 1 week. Secondary outcomes were other metrics of web activity at 1 week.

Results

There was no evidence that disseminating microblogs on different days of the working week resulted in any differences in target website activity as measured by Google Analytics (n=194, all page views, adjusted ratios of geometric means 0.86 (95% CI 0.63 to 1.18), 0.88 (95% CI 0.64 to 1.21), 0.88 (95% CI 0.65 to 1.21), 0.91 (95% CI 0.66 to 1.24) for Tuesday–Friday, respectively, overall p=0.89). There were consistent findings for all outcomes. However, activity on the review site substantially increased compared with weeks preceding the intervention.

Conclusion

There are no clear differences in the effect when 1 weekday is compared with another, but our study suggests that using microblogging social media such as Twitter and Weibo do increase information-seeking behaviour on health. Tweet any day but do Tweet.
Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014: two successive national cross-sectional surveys
Authors: Dong Yanhui , Ma Yinghua , Dong Bin , Zou Zhiyong , Hu Peijin , Wang Zhenghe , Yang Yide , Song Yi , Ma Jun
Published: April 2019

Purpose

The urban-rural disparity for childhood overweight and obesity shows different patterns in most countries. This study aimed to examine the recent trend of urban-rural disparity for childhood overweight and obesity at national and subnational levels in Chinese children from 2010 to 2014.

Design

Two successive national cross-sectional studies. Overweight and obesity were classified using Chinese national age-specific and sex-specific body mass index reference. The prevalence of overweight and obesity was compared between urban and rural areas at national and subnational levels.

Setting

Thirty-one provinces in China.

Participants

Data were obtained from the Chinese National Survey on Students’ Constitution and Health in 2010 and 2014 with 215 214 (107 741 in 2010 and 107 473 in 2014) children aged 7–12 years.

Results

The overweight and obesity prevalence increased from 17.1% in 2010 to 22.5% in 2014. The overweight and obesity prevalence in both urban and rural areas was higher in the eastern provinces but lower in the western provinces. The urban-rural disparity in overweight and obesity decreased steadily from 2010 to 2014 (1.79 to 1.42 for prevalence OR). There was greater urban-rural disparity in western China than eastern China. A reversal occurred in 2014 in several eastern provinces where the overweight and obesity prevalence in rural children surpassed that of their urban peers.

Conclusions

A narrowing urban-rural disparity and the reversal signal between urban and rural areas in overweight and obesity would contribute to a growing proportion of obese children in rural areas. Therefore, urgent region-specific policies and interventions with a forward-looking approach should be considered for Chinese children, especially in rural areas.
Media framing of childhood obesity: a content analysis of UK newspapers from 1996 to 2014
Authors: Nimegeer Amy , Patterson Chris , Hilton Shona
Published: April 2019

Background

Media can influence public and policy-makers’ perceptions of causes of, and solutions to, public health issues through selective presentation and framing. Childhood obesity is a health issue with both individual-level and societal-level drivers and solutions, but public opinion and mass media representations of obesity have typically focused on individual-level framings, at the cost of acknowledgement of a need for regulatory action.

Objective and setting

To understand the salience and framing of childhood obesity across 19 years of UK national newspaper content.

Design and outcome measures

Quantitative content analysis of 757 articles about childhood obesity obtained from six daily and five Sunday newspapers. Articles were coded manually for definitions, drivers and potential solutions. Data were analysed statistically, including analysis of time trends and variations by political alignment of source.

Results

The frequency of articles grew from a low of two in 1996 to a peak of 82 in 2008, before declining to 40 in 2010. Individual-level drivers (59.8%) and solutions (36.5%) were mentioned more frequently than societal-level drivers (28.3%) and solutions (28.3%) across the sample, but societal solutions were mentioned more frequently during the final 8 years, coinciding with a marked decline in yearly frequency of articles.

Conclusions

Increased focus on societal solutions aligns with public health goals, but coincided with a reduction in the issue’s salience in the media. Those advocating public policy solutions to childhood obesity may benefit from seeking to raise the issue’s media profile while continuing to promote structural conceptualisations of childhood obesity.
I-ACT: Integrated study on effect of Activity on ComplicaTions in pregnancy: study protocol of a multiethnic prospective cohort study
Authors: Cai Meijin , Tan Kok Hian , Ang Seng Bin
Published: April 2019

Introduction

Physical activity (PA) during first 20 weeks of pregnancy may lower risks of gestational diabetes mellitus (GDM) and gestational hypertension (GH), though evidence of association remains inconclusive. Current studies rely heavily on subjective assessment of PA levels. Wearable activity trackers provide a convenient and objective surrogate index for PA validated by evidence-based steps/day categorisation along a physical inactivity/activity continuum. I-ACT primarily aims to examine objectively measured PA levels and patterns in first and second trimesters of pregnancy and the association with GDM and/or GH in Singapore, a multiethnic Asian population. Secondary aims include investigating the bio-socio-demographic factors associated with sedentary behaviour, and association of early pregnancy PA level with maternal weight at 6 weeks postdelivery. Results may facilitate identification of high-risk mothers-to-be and formulation of interventional strategies.

Methods and analysis

Prospective cohort study that will recruit 408 women at first antenatal visit at <12 weeks’ gestation. Baseline bio-socio-demographic factors and PA levels assessed by participant characteristics form and the International Physical Activity Questionnaire (IPAQ), respectively. An activity tracker (Fitbit) will be provided to be worn daily from date of recruitment to end of 20 weeks’ gestation. Tracker-recorded data will be synchronised with an application on participant’s smartphone. Compliance will be reinforced with fortnightly reminders. After 20 weeks, a second IPAQ and a feedback form will be administered. GDM screened at 24–28 weeks’ gestation. GH diagnosed after 20-weeks gestation. Maternal weight assessed at 6 weeks postdelivery. Appropriate statistical tests will be used to compare continuous and categorical PA measurements between first and second trimesters. Logistic regression will be used to analyse associations.

Ethics and dissemination

Ethical approval obtained from the Centralised Institutional Review Board of SingHealth (reference 2017/2836). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters and medical forums.
Agreement between capillary and venous lactate in emergency department patients: prospective observational study
Authors: Graham Colin A , Leung Ling Yan , Lo Ronson SL , Lee Kwok Hung , Yeung Chun Yu , Chan Suet Yi , Cattermole Giles N , Hung Kevin KC
Published: April 2019

Objectives

Capillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref).

Design

A prospective observational study.

Setting

A university teaching hospital emergency department in Hong Kong.

Participants

Patients triaged as ‘urgent’ (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited.

Primary and secondary outcome measures

The primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers.

Results

The results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was −0.22 with 95% limits of agreement (LOA) of −2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of −1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being −0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA −0.01 to 1.66 mmol/L.

Conclusion

Our study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing.

Trial registration number

NCT02694887.
Validation of non-participation bias methodology based on record-linked Finnish register-based health survey data: a protocol paper
Authors: McMinn Megan A , Martikainen Pekka , Gorman Emma , Rissanen Harri , Härkänen Tommi , Tolonen Hanna , Leyland Alastair H , Gray Linsay
Published: April 2019

Introduction

Decreasing participation levels in health surveys pose a threat to the validity of estimates intended to be representative of their target population. If participants and non-participants differ systematically, the results may be biased. The application of traditional non-response adjustment methods, such as weighting, can fail to correct for such biases, as estimates are typically based on the sociodemographic information available. Therefore, a dedicated methodology to infer on non-participants offers advancement by employing survey data linked to administrative health records, with reference to data on the general population. We aim to validate such a methodology in a register-based setting, where individual-level data on participants and non-participants are available, taking alcohol consumption estimation as the exemplar focus.

Methods and analysis

We made use of the selected sample of the Health 2000 survey conducted in Finland and a separate register-based sample of the contemporaneous population, with follow-up until 2012. Finland has nationally representative administrative and health registers available for individual-level record linkage to the Health 2000 survey participants and invited non-participants, and the population sample. By comparing the population sample and the participants, synthetic observations representing the non-participants may be generated, as per the developed methodology. We can compare the distribution of the synthetic non-participants with the true distribution from the register data. Multiple imputation was then used to estimate alcohol consumption based on both the actual and synthetic data for non-participants, and the estimates can be compared to evaluate the methodology’s performance.

Ethics and dissemination

Ethical approval and access to the Health 2000 survey data and data from administrative and health registers have been given by the Health 2000 Scientific Advisory Board, Statistics Finland and the National Institute for Health and Welfare. The outputs will include two publications in public health and statistical methodology journals and conference presentations.
Living kidney donor and recipient perspectives on their relationship: longitudinal semi-structured interviews
Authors: Ralph Angelique F , Butow Phyllis , Craig Jonathan C , Wong Germaine , Chadban Steve J , Luxton Grant , Gutman Talia , Hanson Camilla S , Ju Angela , Tong Allison
Published: April 2019

Background and objectives

Many donors and recipients report an improved bond posttransplantation; however, unexpected conflicts and tension may also occur. Insights into the lived experiences of the donor–recipient relationship can inform strategies for interventions and support. We aimed to describe donor and recipient expectations and experiences of their relationship before and after living kidney donor transplantation.

Design, setting and participants

Semistructured interviews were conducted with 16 donor–recipient pairs before the transplant and 11–14 months post-transplant. Transcripts were analysed thematically.

Results

We identified seven themes (with respective subthemes): donation as enacting familial responsibility for care; analytical decision making to mitigate regret (avoiding anticipated regret and maintaining control, removing emotional impulsivity); strengthened interpersonal ties (gaining a deeper appreciation among family members, stronger empathy for each other, improving social participation); instability of relational impacts (anger and aggression threatening dynamics, unanticipated stress and emotional lability, triggering familial tension); renegotiating social roles (unexpected continuation of caregiving responsibilities, inability to relinquish the caregiving role, disappointment with unfulfilled renewal of intimacy, dissatisfaction over discrepant energy levels); guilt over unmet expectations and inevitability of the gift relationship (vague and transient indebtedness, expectation of reciprocity, transferring kidney ownership).

Conclusions

Donor–recipient relationships may be improved through increased empathy, appreciation, and ability to participate in life together; however, unfulfilled expectations and behavioural and emotional changes in recipients (a side effect related to immunosuppression) remain unresolved consequences of living kidney donor transplantation. Education and counselling to help donors and recipients adjust to potential changes in relationship dynamics may help protect and foster relational stability postdonation.
Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study
Authors: Jernberg Tomas , Lindholm Daniel , Hasvold Lars Pål , Svennblad Bodil , Bodegård Johan , Sundell Andersson Karolina , Thuresson Marcus , Erlinge David , Janzon Magnus
Published: April 2019

Objectives

To compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).

Design

Cohort study linking morbidity, mortality and medication data from Swedish national registries.

Participants

First-time users of GLD during 2007–2016.

Outcomes

Predicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.

Results

260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD—prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.

Conclusions

T2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.
Health-related quality of life (HRQOL) in children and adolescents with congenital heart disease: a cross-sectional survey from South India
Authors: Raj Manu , Sudhakar Abish , Roy Rinku , Champaneri Bhavik , Sudevan Remya , Kabali Conrad , Kumar Raman Krishna
Published: April 2019

Objective

There are limited data on health-related quality of life (HRQOL) for children and adolescents with uncorrected congenital heart disease (CHD) from low-income and middle-income countries where late presentation is common. We sought to compare HRQOL of children and adolescents with uncorrected CHD to that of controls using the Pediatric Quality of Life Inventory (PedsQL 4.0).

Methods

The study design is a cross-sectional analytical survey. The study setting was (1) Hospital-based survey of patients with CHD and their parents. (2) Community survey of controls and their parents. Subjects included (1) Children/adolescents with CHD between the ages of 2 years and 18 years and their parents enrolled in a previous study (n=308). (2) Unmatched community controls (719 children/adolescents, aged 2–18 years) and their parents. Participants were given PedsQL 4.0 to fill out details. Parents assisted children 5–7 years of age in filling the questionnaires. Children younger than 5 years had only parent-reported HRQOL and those above 5 years had both self-reported and parent-reported HRQOL.

Results

The median (IQR) total generic HRQOL from self-reports for CHD subjects and controls were 71.7 (62.0, 84.8) and 91.3 (82.6, 95.7), respectively. The corresponding figures for parent-reports were 78.3 (63.0, 90.5) and 92.4 (87.0, 95.7) respectively. The adjusted median difference was −20.6 (99% CI −24.9 to −16.3, p<0.001) for self-reported and −14.1 (99% CI −16.7 to −11.6, p<0.001) for parent-reported total HRQOL between patients with CHD and controls. Cardiac-specific HRQOL by self-reports was 75.0 (53.6, 92.9) for heart problems, 95.0 (73.8, 100.0) for treatment barriers, 83.3 (66.7, 100.0) for physical appearance, 87.5 (62.5, 100.0) for treatment-related anxiety, 91.7 (68.8, 100.0) for cognitive problems and 83.3 (66.7, 100.0) for communication. The values for parent-reports were 71.4 (53.6, 85.7), 100.0 (75.0, 100.0), 100.0 (75.0, 100.0), 81.3 (50.0, 100.0), 100.0 (81.2, 100.0) and 83.3 (50.0, 100.0), respectively.

Conclusions

Children and adolescents with uncorrected CHD reported significant reductions in overall quality of life compared with controls.
PP19 Opioid poisoning deaths: a national picture
Authors: Jones Matthew , Snooks Helen , Angela Evans Bridie , Watkins Alan , Fuller Gordon
Published: April 2019

Background

The factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents of opioid poisoning in Wales in 2015. Using anonymised linked data, we describe demographic characteristics, patterns of emergency service utilisation, and clinical presentation prior to death.

Methods

Decedents of opioid poisoning in Wales in 2015 were identified from Office of National Statistics (ONS) mortality data. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymised Information Linkage (SAIL) databank. Data were accessed and analysed in the SAIL gateway.

Results

Age at death ranged from eighteen to seventy-eight years, with a mean of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-six percent of decedents were men (n=98/112).

Eight-seven percent of decedents (n=112/129) attended the emergency department in the three years prior to death; eighty-nine in the previous year, ninety-nine in the previous two years and 112 in the previous three years. Eighty-four percent of male and ninety-three percent of female decedents attended the ED in the three years prior to death.

In total 665 attendances were made, half of which involved conveyance by ambulance. Attendances per individual ranged from one to sixty, with over half of decedents attending more than three times.

Diagnostic codes were mostly missing or non-specific, with only six and a half percent of attendances representing twenty seven decedents, coded as drug related.

Conclusions

Matching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilisation. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.
PP25 Decision-making in ambulance service non-conveyance – the DMASC survey
Authors: Black Sarah , Frampton Ian
Published: April 2019

Background

A variety of factors influence the decision making of pre-hospital clinicians when considering conveying patients to the Emergency Department. This study aimed to explore the utility of a novel psychometric tool that identifies elements involved in the decision to leave a patient at scene following a 999 call.

Methods

The Decision-making in Ambulance Service non-Conveyance (DMASC) Scale was used to survey 350 pre-hospital clinicians from one NHS Ambulance Trust. Items pertaining to four subscales: the autonomy with which non-conveyance decisions were made; steps taken to safeguard those decisions; the impact of previous experience; and patient characteristics influencing the decision, were explored. The DMASC scale was followed by the REI-40, a validated psychometric survey that determines preferred decision-making style.

Results

Responses from 121 participants indicated clinicians felt they make autonomous decisions, with little involvement of other Health Care Professionals. There were no overall significant differences between clinical grades and DMASC scores, although there was a significant interaction between grade and the subscales Experience and Patient Characteristics, more skilled practitioners scored higher. There was no overall difference in the length of service and DMASC score, although there was a significant difference between staff in post <2 years, and those in post for between 7–15 years on the Safety Netting subscale. Scores from the REI-40 showed no overall significant differences between clinical grades, although those with between 3–6 years’ experience scored significantly higher on the Rational scale than those with 7–15 years’ experience.

Conclusions

Implications for practice arising from these Results indicate clinical mentorship of newly qualified paramedics should be formalised to support safe decision-making when leaving patients at home. It also suggests that Specialist Paramedics may be using different decision-making heuristics than other grades to inform their confidence in leaving patients at the scene.
PP30 ‘I can’t remember’ – patients views of receiving pain management from paramedics for suspected hip fracture
Authors: Evans Bridie , Brown Alan , Bulger Jenna , Fegan Greg , Ford Simon , Guy Katy , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Pallister Ian , Rees Nigel , Russell Ian , Seagrove Anne , Snooks Helen
Published: April 2019

Background

Up to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture.

Objective

To explore patients’ views and experience of care received for suspected hip fracture and in particular FICB before ambulance transport to hospital.

Method

We interviewed six patients and the daughter of a patient who received FICB to manage their suspected hip fracture. Interviews, by telephone or face-to-face, were audio-recorded with consent. We conducted thematic analysis of transcripts. Two researchers, one paramedic and one lay member were in the analysis team

Results

Respondents’ memory of prehospital care was dominated by their experience of extreme pain. While they recalled events before falling, they only had partial memory of care prior to hip surgery. Although they recalled paramedics’ arrival, which they reported was up to six hours after their injury, respondents said they remembered little else. Just one recalled consenting to receiving FICB and could describe the process. Other respondents said they were in too much pain to comprehend what occurred or respond coherently. They explained their priority was to receive pain management and they expected the paramedics to treat them safely and effectively. Respondents appeared to be a stoical and trusting group who accepted the treatment they were offered. They did recall high quality of care and praised paramedics for their reassuring and calm manner.

Conclusions

Hip fracture patients’ overwhelming memory of injury and treatment was of pain and their priority was to receive pain relief. The quality of care, reassurance and administration of pain management was more important to patients than the mechanism of delivering the intervention.
04 Using electronic patient records collected by ambulance personnel to detect disease outbreaks
Authors: Reich Thilo
Published: April 2019

Background

The introduction of electronic patient records in the ambulance service allows to use these to monitor the population. Most patients are discharged at scene therefore this data represents a new source for syndromic disease surveillance. The accessibility and extent of the records allows to apply early event detection (EED) systems to monitor the prehospital population. Here such a system is applied to tympanic temperature readings to detect seasonal influenza.

Method

Tympanic temperature readings, are recorded for all patients and were used to determine daily and weekly numbers of pyretic patients. A method adapted from Singh et al. (2016) based on case ratios (CR) was used to detect the start of the seasonal influenza outbreak. This method does not rely on thresholds, and was applied in a sliding manor as EED system.

Results

The data represented annually 15.96% of the population, focused on the elderly. It matched the progress of seasonal influenza cases from sentinel surveillance programs. For the season 2016/17 an increase in cases was detected with an estimated specificity and sensitivity of 99.7% and 100%, up to 9 weeks before sentinel surveillance programs. Furthermore, an unanticipated outbreak of Escherichia coli was detected.

Conclusion

It was shown, disease outbreaks can be monitored using prehospital tympanic temperature data. Thus, making the ambulance service an ideal source for syndromic surveillance. The method used was effective and can be easily deployed to monitor specific syndromes to distinguish between infectious agents. The method is easily adapted to sample rates and noisiness of the data to prevent false alarms.
OP5 Rapid analgesia for prehospital hip disruption (RAPID): findings from a randomised feasibility study
Authors: Bulger Jenna , Brown Alan , Evans Bridie , Fegan Greg , Ford Simon , Guy Katy , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Pallister Ian , Rees Nigel , Russell Ian , Seagrove Anne , Snooks Helen
Published: April 2019

Background

Adequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians in the emergency department for patients with hip fracture, but has not been fully evaluated for use by paramedics in prehospital care.

We aimed to test whether FICB for hip fracture pain relief carried out by paramedics in prehospital care was feasible, safe and acceptable, and whether trial Methods were viable, so that we could decide whether to proceed to a fully-powered RCT to evaluate clinical and cost effectiveness.

Methods

Nineteen paramedics were trained to administer FICB. They randomly allocated eligible patients to FICB or usual care using audited scratchcards. Patients were followed up to assess availability of key outcomes including quality of life, length of hospital stay, pain scores, and adverse events. Findings were analysed against pre-specified feasibility criteria to determine whether it was appropriate to progress to a fully-powered trial.

Results

Seventy-one patients were randomised by paramedics between 28/6/16 and 31/7/17; 57 of these patients consented to follow up. The only outcome which reached a statistically significant difference between groups was the proportion of participants who received morphine (38% difference between groups 95% CI −61.88 to −15.79). There was a difference of approximately nine days in the length of stay between trial arms (mean difference 9.12 (95% CI −20.51 to 2.27).

Conclusions

RAPID met its pre-specified progression criteria; a funding application for a fully-powered RCT will therefore be submitted. We will consider the use of length of stay as the primary outcome measure, as feasibility study findings indicated that there was a difference between groups without reaching statistical significance.
Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia
Authors: Nedkoff Lee , Goldacre Raphael , Greenland Melanie , Goldacre Michael J , Lopez Derrick , Hall Nick , Knuiman Matthew , Hobbs Michael , Sanfilippo Frank M , Wright F Lucy
Published: April 2019

Background

Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013.

Methods

CHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression.

Results

From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention.

Conclusions

Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
Cardiac magnetic resonance in patients with elevated troponin and normal coronary angiography
Authors: Bhatia Subir , Anstine Christopher , Jaffe Allan S , Gersh Bernard J , Chandrasekaran Krishnaswamy , Foley Thomas A , Hodge David , Anavekar Nandan S
Published: April 2019

Background

Invasive angiography in the setting of cardiac troponin elevation may reveal non-obstructive coronary arteries leading to uncertainty in diagnosis. Cardiac MR (CMR) may aid in diagnosis, however, the spectrum of diagnostic findings in the patient presenting with symptoms of cardiac ischaemia, elevated cardiac biomarkers and a negative invasive coronary angiogram is yet to be completely described.

Methods

We queried the Mayo Clinic, Rochester inpatient record from 1 January 2000 to 31 December 2016 to identify patients who: (1) had an elevated troponin T during admission, (2) underwent coronary angiography within 30 days of troponin T elevation which was considered negative for obstructive coronary arterial disease and (3) underwent CMR within 30 days of troponin T elevation. CMR diagnoses were classified as either (1) myocarditis, (2) small area myocardial infarction, (3) stress cardiomyopathy, (4) non-ischaemic cardiomyopathy or (5) normal.

Results

Of 215 patients, the spectrum of disease seen on CMR was myocarditis (32%), small area infarction (22%), non-ischaemic cardiomyopathy (20%) and stress cardiomyopathy (9.3%).

Conclusion

In the largest single-centre study assessing the role of CMR in patients admitted with elevated troponin T with a non-obstructive coronary disease on an angiogram, small area infarction was seen in 22% of patients.
Sex differences in publication volume and quality in congenital heart disease: are women disadvantaged?
Authors: van Doren Sophie , Brida Margarita , Gatzoulis Michael A , Kempny Aleksander , Babu-Narayan Sonya V , Bauer Ulrike M M , Baumgartner Helmut , Diller Gerhard Paul
Published: April 2019

Background

Women are underrepresented in leading medical positions and academia. The gender-gap in authorship of congenital heart disease (CHD) publications remains unknown. As determinants of gender equity in this field are poorly characterised, we aimed to quantify and characterise publications in CHD and to assess factors associated with female representation in research.

Methods and results

We identified 35 118 CHD publications between 2006 and 2015 for which author gender could be ascertained. Overall, 25.0% of all authors were female. Women accounted for 30.2% and 20.8% of all first and senior authorship positions with great geographic heterogeneity. While globally female first and senior authorship increased by 0.8% and 0.6%/year, some geographic regions showed no improvement in gender representation. Significant predictors of female first authorship on logistic regression analysis were country gross domestic product, human development index, gender inequality index and a female senior author (p<0.0001 for all). Publications with a female lead author tended to be published in journals with a higher impact factor (IF) and to attract more citations compared with those with a male author. Mixed gender authorship was associated with higher IF and number of citations. Women were less disadvantaged when the analysis was confined to original research.

Conclusions

While modest improvement in female authorship over time was noted, women remain underrepresented in contemporary academic CHD. Manuscripts with mixed gender authorship had higher IF and more citations. The main predictor of female first authorship was a female senior author. These data should inform policy recommendations regarding gender parity.
Noticing in neurology
Authors: Lees A J
Published: April 2019

There are three classes of people: those who see, those who see when they are shown, those who do not see

Leonardo da Vinci

The three cardinal qualities necessary for the ideal neurologist are observation, the ability to reason backwards inferentially and specialist knowledge. Modern medical technology has greatly increased the ability to diagnose and treat disease but it has also encouraged a benign variant of abulia, which is killing off the art and science of clinical reasoning. Intent gazing at the unfamiliar with old eyes or a long look at the familiar with new eyes offers the neurologist an opportunity to discover hitherto unnoticed diagnostic signs far beyond the resolution of the brain scanner and even the light microscope. While there may be nothing new under the sun, there are plenty of old things that no one has observed, which have the potential to greatly improve clinical practice.
The future and the vet profession
Authors: Trees Lord
Published: April 2019

One of the biggest challenges facing the veterinary profession is being able to provide affordable health care while better rewarding those that provide that care. Here, Lord Trees argues that delegation of responsibilities and embracing technology are two solutions to this problem.