bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention
Authors: Huynh Julie , Hodgson Kate A , Boyce Suzanne , Ibrahim Laila F , Bryant Penelope A 
Published: May 2020

BackgroundAs treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care.ObjectivesWe aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing.DesignA prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014).SettingThe Hospital-in-the-Home (HITH) programme at The Royal Children’s Hospital Melbourne.ParticipantsAll patients who received OPAT during the study period.InterventionsBetween the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases.Main outcomesSuccessful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness.ResultsOver 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8–24.5) to 8 (IQR 5–11).ConclusionDuring a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.
Cluster randomised controlled trial of home cook intervention to reduce salt intake in China: a protocol study
Authors: Zhang Xiaochang , Hu Xiao , Ma Jixiang , Zhang Puhong , Li Yuan , Luo Rong , He Feng J , MacGregor Graham A , Wang Jinglei , Yin Zhaoxue 
Published: May 2020

IntroductionSalt intake in China is twice the upper limit recommended by the WHO, and nearly 80% of salt is added during cooking. This study will develop a package of salt reduction interventions targeting home cooks and evaluate its effectiveness and feasibility for scale-up.Methods and analysisA cluster randomised controlled trial design is adopted in this study, which will be conducted in six provinces covering northern, central and southern China. For each province, 10 communities/villages (clusters) with 13 families (one cook and one adult family member) will be selected in each cluster for evaluation. In total, 780 home cooks and 780 adult family members will be recruited. The home cooks in the intervention group will be provided with the intervention package, including community-based standardised offline and online health education and salt intake monitoring. The duration of the intervention will be 1 year. The primary outcome is the difference between the intervention and control group in change in salt intake as measured by 24 hours urinary sodium from baseline to the end of the trial. The secondary outcome is the difference between the two groups in the change in salt-related knowledge, attitude and practice and blood pressure (BP).Ethics and disseminationThe study has been approved by The Queen Mary Research Ethics Committee (QMERC2018/13) and Institutional Review Board of the Chinese Center for Disease Control and Prevention (No. 201801). The study findings will be disseminated widely through conference presentations and peer-reviewed publications and the general media.Trial registration numberChiCTR1800016804.
Adolescent follow-up in the Health Outcomes and Measures of the Environment (HOME) Study: cohort profile
Authors: Braun Joseph M , Buckley Jessie P , Cecil Kim M , Chen Aimin , Kalkwarf Heidi J , Lanphear Bruce P , Xu Yingying , Woeste Anastasia , Yolton Kimberly 
Published: May 2020

PurposeEnvironmental chemical exposures may adversely affect an array of adolescent health outcomes. Thus, we used the Health Outcomes and Measures of the Environment (HOME) study, a prospective cohort that recruited pregnant women and conducted longitudinal follow-up on children over the first 12 years of life, to determine if and when chemical exposures affect adolescent health.ParticipantsWe recruited 468 pregnant women (age range: 18–45 years) from the Cincinnati, Ohio region to participate in a cohort study between March 2003 and January 2006. Follow-up included two clinic and one home visits during pregnancy, a delivery hospital visit, and four home and six clinic visits when children were aged 4 weeks and 1, 2, 3, 4, 5 and 8 years. Of 441 children available for follow-up, 396 (90%) completed at least one follow-up and 256 (58%) completed the most recent follow-up at 12 years of age (range: 11–14).Findings to dateOur new measures include maternal/child report of internalising symptoms, neuroimaging, dual-energy X-ray absorptiometry-derived estimates of lean/adipose tissue and bone mineral density, and cardiometabolic risk biomarkers. We assessed adolescent exposure to perfluoroalkyl substances, phenols, phthalates and flame retardants. Participants completing follow-up at 12 years of age were similar to the original cohort in terms of baseline factors. Most children had typical and expected values for this age on measures of internalising symptoms, body composition, bone density and cardiometabolic risk markers. Notably, 36% and 11% of children had scores indicative of potential anxiety and depressive disorders, respectively. Approximately 35% of children were overweight or obese, with higher prevalence among girls. Thirty-three per cent of children had borderline or high triglyceride concentrations (>90 mg/dL).Future plansWe will examine associations of early life environmental chemical exposures with adolescent health measures while considering potential periods of heightened susceptibility and mixture effects.Trial registration numberNCT00129324.
Evaluation of a continuous neonatal temperature monitor for low-resource settings: a device feasibility pilot study
Authors: Sosa Saenz Sonia E. , Hardy Mary Kate , Heenan Megan , Oden Z. Maria , Richards-Kortum Rebecca , Dube Queen , Kawaza Kondwani 
Published: May 2020

ObjectiveEvaluate a novel continuous temperature monitor in a low-resource neonatal ward.DesignWe developed a low-cost continuous neonatal temperature monitor (NTM) for use in low-resource settings. Accuracy of NTM was initially assessed in the laboratory. Clinical evaluation then was performed in a neonatal ward in a central hospital in Malawi; eligible neonates (<1 week of age) were recruited for continuous temperature monitoring with NTM and a Philips Intellivue MP30 Patient Monitor.Interventions and outcome measuresThe temperature probes of NTM and the reference patient monitor were attached to the infant’s abdomen, and core temperature was continuously recorded for up to 3 hours. Axillary temperatures were taken every hour. We compared temperatures measured using NTM, the patient monitor and the axillary thermometer.ResultsLaboratory temperature measurements obtained with NTM were within 0.059°C (range: −0.035°C to 0.195°C) of a reference thermometer. A total of 39 patients were recruited to participate in the clinical evaluation of NTM; data from four patients were excluded due to faulty hardware connections. The mean difference in measured temperatures between the NTM and the Intellivue MP30 was −0.04°C (95% CI −0.52°C to 0.44°C).ConclusionNTM meets ISO 80601-2-56 standards for accuracy and is an appropriate, low-cost continuous temperature monitor for neonatal wards in low-resource settings.Trial registration numbersNCT03965312 and NCT03866122.
Evaluation of ‘care bundles’ for patients with chronic obstructive pulmonary disease (COPD): a multisite study in the UK
Authors: Morton Katherine , MacNeill Stephanie , Sanderson Emily , Dixon Padraig , King Anna , Jenkins Sue , Metcalfe Chris , Shaw Ali , Chalder Melanie , Benger Jonathan , Hollingworth William , Calvert James , Purdy Sarah 
Published: May 2020

BackgroundChronic obstructive pulmonary disease (COPD) accounts for 10% of emergency hospital admissions in the UK annually. Nearly 33% of patients are readmitted within 28 days of discharge. We evaluated the effectiveness of implementing standardised packages of care called ‘care bundles’ on COPD readmission, emergency department (ED) attendance, mortality, costs and process of care.MethodsThis is a mixed-methods, controlled before-and-after study with nested case studies. 31 acute hospitals in England and Wales which introduced COPD care bundles (implementation sites) or provided usual care (comparator sites) were recruited and provided monthly aggregate data. 14 sites provided additional individual patient data. Participants were adults admitted with an acute exacerbation of COPD.ResultsThere was no evidence that care bundles reduced 28-day COPD readmission rates: OR=1.02 (95% CI 0.83 to 1.26). However, the rate of ED attendance was reduced in implementation sites over and above that in comparator sites (implementation: IRR=0.63 (95% CI 0.56 to 0.71); comparator: IRR=1.12 (95% CI 1.02 to 1.24); group–time interaction p<0.001). At implementation sites, delivery of all bundle elements was higher but was only achieved in 2.2% (admissions bundle) and 7.6% (discharge bundle) of cases. There was no evidence of cost-effectiveness. Staff viewed bundles positively, believing they help standardise practice and facilitate communication between clinicians. However, they lacked skills in change management, leading to inconsistent implementation.DiscussionCOPD care bundles were not effectively implemented in this study. They were associated with a reduced number of subsequent ED attendances, but not with change in readmissions, mortality or reduced costs. This is unsurprising given the low level of bundle uptake in implementation sites, and it remains to be determined if COPD care bundles affect patient care and outcomes when they are effectively implemented.Trial registration numberISRCTN13022442.
Positive predictive value of stroke identification by ambulance clinicians in North East England: a service evaluation
Authors: McClelland Graham , Flynn Darren , Rodgers Helen , Price Christopher 
Published: May 2020

Introduction/backgroundAccurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England.MethodsThis service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy.ResultsAmbulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine.DiscussionIn this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity.
Next-generation sequencing and histological response assessment in peritoneal metastasis from pancreatic cancer treated with PIPAC
Authors: Nielsen Malene , Graversen Martin , Ellebæk Signe Bremholm , Kristensen Thomas Kielsgaard , Fristrup Claus , Pfeiffer Per , Mortensen Michael Bau , Detlefsen Sönke 
Published: May 2020

BackgroundPeritoneal metastasis from pancreatic cancer (PM-PC) may be treated with repeated pressurised intraperitoneal aerosol chemotherapy (PIPAC). Utility of next-generation sequencing (NGS) to detect cancer-related mutations in peritoneal quadrant biopsies (QBs) and peritoneal fluid (PF) after systemic and PIPAC treatment has not been evaluated. Around 90% of pancreatic cancers (PCs) harbour aKRASmutation, making PC ideal for the evaluation of this aspect.AimsEvaluation of PM-PC in terms of (1) histological response to PIPAC using Peritoneal Regression Grading Score (PRGS), (2) clinical characteristics and (3) frequency of mutations in QBs and PF before and after PIPAC.MethodsPeritoneal QBs and PF were obtained prior to each PIPAC. NGS for 22 cancer-related genes was performed on primary tumours, QBs and PFs. Response was assessed by the four-tiered PRGS.ResultsSixteen patients treated with a median of three PIPAC procedures were included. The mean PRGS was reduced from 1.91 to 1.58 (p=0.02). Fifty-seven specimens (13 primary tumours, 2 metastatic lymph nodes, 16 PFs and 26 QB sets) were analysed with NGS.KRASmutation was found in 14/16 patients (87.50%) and in QBs, primary tumours and PF in 8/12 (66.67%), 8/13 (61.53%) and 6/9 (66.67%). The median overall survival was 9.9 months (SE 1.5, 95% CI 4.9 to 13.9).ConclusionPIPAC induces histological response in the majority of patients with PM-PC.KRASmutation can be found in PM-PC after PIPAC at a frequency similar to the primaries. NGS may be used to detect predictive mutations in PM-PC of various origins, also when only post-PIPAC QBs or PFs are available.
O4E.2 Efficiency of autocoding programs for converting job descriptors into standard occupational classification codes
Authors: Dale Ann , Buckner-Petty Skye , Evanoff Bradley 
Published: May 2020

IntroductionStandard Occupational Classification (SOC) codes can link work exposure data to individual health outcomes, but manually assigning job codes is laborious. We tested two recently developed automatic coding programs.MethodsWe entered self-reported job titles and industry from two existing cohorts into two publicly available autocoding programs, the NIOSH Industry and Occupation Computerized Coding System (NIOCCS) and the Standardized Occupation Coding for Computer-assisted Epidemiological Research (SOCcer), and assessed agreement between autocodes and manual coding. We also assessed agreement of several exposure values (from the Occupational Information Network, O*NET) linked by manual SOC codes versus those linked by autocodes, in order to examine how differences in coding might affect exposure assignments in general population cohort studies.ResultsNIOCCS produced SOC codes for the majority of subjects (Cohort 1: 85%; Cohort 2: 79%). The level of detail for these codes varied slightly; 6-digit SOC codes (detailed occupations) were available for 84% and 76% of cohorts A and B respectively. Comparison to manual codes showed strong agreement at the major group level (kappa=0.8 for both cohorts) and weaker agreement at the 6-digit level (kappa ≥0.4 and 0.6). SOCcer produced 6-digit SOC codes for all subjects with good agreement at the 2-digit level (kappa ≥0.6 and 0.7) and slightly lower at the 6-digit level (kappa ≥0.3 and 0.4). Agreement for O*NET exposures was very high for most comparisons within both cohorts for both programs (many ICCs>0.8).ConclusionBoth autocoding programs can be reliable tools to aid in assigning SOC codes that represent broad industry levels, with less agreement at finer levels of job codes. Given the availability of large public datasets with job information but no other work exposure data, autocoding of jobs provides exciting opportunities for analyzing work-related health outcomes in future studies.
O4E.3 Utility of routinely recorded data on working hours for an epidemiological cohort study of 60,000 swedish health care employees
Authors: Gustavsson Per , Bigert Carolina , Bodin Theo , Selander Jenny , Härmä Mikko , Lindahl-Norberg Annika , Andersson Tomas , Gustavsson Annika , Albin Maria 
Published: May 2020

Night and shift work is common in industry and service that must be functional 24 hour. Night work disrupts the circadian rhythm, and is potentially linked to an excess of cancer (especially breast cancer), cardiovascular disease, pregnancy complications, as well as to psychical effects. Large studies with detailed and objectively collected data on working hours are needed to confirm causal associations and develop practical advice on how shift schedules should be planned in order to minimize negative health effects.Stockholm County Council employs a high number of health care workers of which many are working in shifts. We have formed a cohort of those employed from 2008 to 2016, 45 000 women and 15 000 men. The computerized employment register holds individual records on working hours day by day in retrospect since 2008, and information on night work since year 2000. Information on cancer incidence, hospital discharge diagnoses of cardiovascular disease, pregnancy outcome, and causes of sick-leave have been obtained from national central registers.There were typically three work shifts: morning shifts (07–15), afternoon shifts (14–21), and night shifts (21–07). Non shift-workers typically worked (08–17). So far, we have investigated work shift patterns for those with a high percentage of night work: nurses, assistant nurses and midwives. Among these, 22% worked at least one night per month, and 15% worked at least 5 nights per month in 2009, which increased slightly to 23% and 16% respectively in 2016. It was common to work several nights in a row: in 2009 13.8% worked at least 3 consecutive nights or more per month, which increased to 15.5% in 2016. Only 0.6% worked 5 consecutive nights or more per month.Analyses of cancer, pregnancy outcome, cardiovascular disease and psychical outcomes are planned for 2019.
O5B.2 Dermal exposure to solvents: a need for quantitative analysis
Authors: Duca Radu-Corneliu , Moldovan Horatiu , Creta Matteo , Poels Katrien , Voidazan Septimiu , Godderis Lode , Vanoirbeek Jeroen 
Published: May 2020

For many years, airborne exposure was considered as the main work-related exposure and efforts have been made both on air monitoring and reduction of respiratory exposure. Nevertheless, recent studies have shown that preventive strategies with an exclusive focus on airborne exposures may falsely indicate a ‘safe’ environment. In 2014, WHO highlighted the importance of dermal exposure and its potential impact on human health. Moreover, it stipulated that the current technical and knowledge gaps related to the assessment of skin exposure have major lacunae.In this context, there is an increased demand for standardized methods and tools for measuring and assessing skin exposure to hazardous agents.We have developed an analytical method to simultaneously identify and quantify 195 volatile organic compounds (VOC) in dermal patches with activated charcoal cloth (ACC). Furthermore, we have done several field studies in different industrial settings, by the simultaneous assessment of dermal exposure using the ACC patches (on the hand, arm and neck), together with assessment of the respiratory exposure and determining the actual internal dose via urinary biomonitoring. Toluene, acetone and styrene exposure was found in a thermoplastic panel factory, styrene exposure in a composites body parts manufacturer, limonene and 1-methoxy-2-propanol exposure in a company that produces and prints plastic cartridges, and acetone and toluene in a pharmaceutical company. The results obtained from the quantitative ACC patches have been compared to the data obtained using Riskofderm for skin exposure, and the penetration through the skin was further estimated using IH-Skinperm and correlated with biomonitoring results.Based on the analytical development and the results of the different field studies, we can conclude that ACC patches represent a suitable technique to evaluate the deposition of VOCs on the skin. We further believe that assessing dermal exposure to solvents using ACC patches can substantially improve occupational health programs.
O5B.4 Workers’ compensation claims for occupational contact dermatitis: 20 years of data from victoria, australia
Authors: Keegel Tessa , Black Ollie , MacFarlane Ewan , Stuckey Rwth , LaMontagne Anthony , Nixon Rosemary , Sim Malcolm 
Published: May 2020

BackgroundOccupational contact dermatitis is one of the most common occupational diseases, but there is a lack of reliable information on incidence. Despite acknowledged limitations, workers’ compensation statistics may provide insights into contact dermatitis patterns.ObjectiveThe objective of the study was to characterise historical patterns of workers’ compensation claims for occupational contact dermatitis.MethodsThis was a retrospective analysis of workers’ compensation claims for occupational contact dermatitis from 1996–2015 (n=3,348) accepted by WorkSafe Victoria in Victoria, Australia. Accepted claims per 1 00 000 person-years stratified by sex, age and industry were calculated. Denominators for the population at risk were obtained from the Australian Bureau of Statistics using Victorian Labour Force Survey data.ResultsThe compensation claims rate of occupational contact dermatitis was 6.72 per 1 00 000 person-years for the overall twenty-year period. There was a significant reduction in claims from 11.84 in 1996 to 1.78 in 2015. Males had a higher overall claims rate of 7.97 compared to the rate for females of 5.18. Over the twenty-year period the rate for males decreased from 14.46 to 1.7 compared to a reduction from 8.4 to 1.8 for females. This decrease was still observed when the data were standardised for underlying changes in the age structure of the population. There was an overall decline across all high-risk occupational groupsConclusionsThere was a fivefold decrease in accepted claims for occupational contact dermatitis for the twenty-year period from January 1996 to December 2015 for the state of Victoria in Australia. These results need to be regarded with caution as the declining rate of accepted occupational contact dermatitis claims may indicate changes in workplace dermal exposures or improvements in workplace skin protection practices over time, or they may be driven by underlying changes to the workers’ compensation system or changes to claims behaviour amongst workers.