bluuebunny/crossref_metadata_2025_split huggingface dataset:
Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study
Authors: Brand Aarent RT , Houben Eline , Bezemer Irene D , Visseren Frank L J , Bots Michiel L , Herings Ron MC , de Borst Gert-Jan 
Published: January 2021

ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.
General populations’ preferences for colorectal cancer screening: rationale and protocol for the discrete choice experiment in the SIGMO study
Authors: Brinkmann Melanie , Diedrich Leonie , Krauth Christian , Robra Bernt-Peter , Stahmeyer Jona Theodor , Dreier Maren 
Published: January 2021

IntroductionIn Germany, the organised colorectal cancer (CRC) screening programme includes the immunologic faecal occult blood test and colonoscopy. The sigmoidoscopy is recommended for individuals rejecting colonoscopy but is not included into the screening programme. To examine whether the evidence based sigmoidoscopy should be additionally offered, the first objective of this study is to evaluate the demand for sigmoidoscopy by analysing the German general populations’ preferences for CRC screening.Methods and analysisPreference data will be collected using a discrete choice experiment (DCE). Identification and selection of the attributes and their levels will be supported by evidence resulting from a systematic literature search and focus groups. An efficient, fractional factorial choice design will be generated. In a cross-sectional study, the DCE will be administered as a written questionnaire to a random sample of 4000 members of the statutory health insurance company in Lower Saxony (AOK Lower Saxony). Insured persons 50–60 years of age without CRC or a chronic inflammatory bowel disease will be eligible. The collected choice data will be analysed by conducting a conditional logit regression model and latent class models.Ethics and disseminationEthical approval for this study was obtained from the Ethics Committee of Hannover Medical School (reference number 8671_BO_K_2019). The study results will be disseminated via conference presentations, publications in peer-reviewed journals and, to participants, the membership magazine of the AOK Lower Saxony.Trial registration numberDRKS00019010.
Association between objectively measured body composition, sleep parameters and physical activity in preschool children: a cross-sectional study
Authors: Wyszyńska Justyna , Matłosz Piotr , Asif Muhammad , Szybisty Agnieszka , Lenik Paweł , Dereń Katarzyna , Mazur Artur , Herbert Jarosław 
Published: January 2021

ObjectiveAssociations between self-reported sleep duration and obesity indices in children are well recognised; however, there are no studies on associations between objectively measured other sleep parameters and physical activity with body composition in preschoolers. Therefore, the aim of this study was to determine the associations between sleep parameters and moderate-to-vigorous physical activity (MVPA) with body composition indices in preschoolers using objective measures.DesignA cross-sectional study.ParticipantsThe study group consisted of 676 children aged 5–6 years, who were enrolled in kindergartens in the 2017/2018 school year.Outcome measuresSleep parameters and MVPA were measured using accelerometers for 7 days. Bioelectrical impedance analysis was used to estimate body composition.ResultsSleep duration and sleep efficiency were inversely associated with body fat percentage (BFP) (β=−0.013 and β from –0.311 to −0.359, respectively) and body mass index (BMI) (β from −0.005 to −0.006 and from −0.105 to –0.121, respectively), and directly associated with fat-free mass (FFM) (β from 0.010 to 0.011 and from 0.245 to 0.271, respectively) and muscle mass (β from 0.012 to 0.012 and from 0.277 to 0.307, respectively) in unadjusted and adjusted models. BFP was inversely associated with MVPA and positively associated with number of awakenings and sleep periods. Number of sleep periods was inversely associated with FFM, and positively with BMI and muscle mass. Correlation matrix indicated significant correlation between BFP, FFM and muscle mass with sleep duration, sleep efficiency, number of sleep periods and MVPA.ConclusionsPeriodic assessment of sleep parameters and MVPA in relation to body composition in preschool children may be considered, especially in those who are at risk for obesity.
Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial
Authors: de Nooijer Kim , Pivodic Lara , Van Den Noortgate Nele , Pype Peter , Van den Block Lieve 
Published: January 2021

IntroductionThere is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention.Methods and analysisWe will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8–11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors.Ethics and disseminationThe study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal.Trial registration numberISRCTN39282347; Pre-results.
Evaluating the feasibility and acceptability of a co-design approach to developing an integrated model of care for people with multi-morbid COPD in rural Nepal: a qualitative study
Authors: Yadav Uday Narayan , Lloyd Jane , Baral Kedar Prasad , Bhatta Narendra , Mehata Suresh , Harris Mark 
Published: January 2021

ObjectiveTo understand the feasibility and acceptability of a co-design approach to developing an integrated model of healthcare for people with multi-morbid chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsA rural setting of Nepal.ParticipantsData collection included five video recordings, five key informant interviews and observation notes from a final co-design workshop that involved a total of 68 stakeholders: persons with COPD and their family members; healthcare providers, including respiratory physicians; local community leaders; representatives from local, provincial and federal government; academics; and representatives from non-government organisations.Primary and secondary outcome measure(s)Feasibility and acceptability of using a co-design approach to develop an integrated model of care for people with multi-morbid COPD in rural Nepal.ResultsOur qualitative evaluation of the Hasso Plattner’s co-design process found that all stakeholders (including people with COPD/community members, primary care practitioners and local government/senior health officials) were actively engaged in and significantly contributed to the process of co-design. Four main themes were identified which determined the feasibility and acceptability of the resulting integrated model of care: engagement of stakeholders, factors contributing to the co-design, consequences of the co-design process, and challenges and opportunities learnt by the researchers and participants in the co-design process. Based on the relationship between the four main themes emerging from this research, we developed an evaluation framework to guide the co-design of a health service innovation.ConclusionOur study demonstrated the feasibility and acceptability of the Hasso Plattner’s co-design process. Our findings suggest that this co-design approach can be useful and acceptable
to local communities and government agencies. It enabled the meaningful contribution of a
diverse group of stakeholders in the design and delivery of health services in low-income and middle-income countries.
Development of the PriCARE classification for potentially preventable emergency department visits by ambulance: a RAND/UCLA modified Delphi study protocol
Authors: Strum Ryan P , Tavares Walter , Worster Andrew , Griffith Lauren E , Rahim Ahmad , Costa Andrew P 
Published: January 2021

IntroductionOntario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care–like patient conditions.ObjectiveTo construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data.Methods and analysisThe Primary Care–like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals.Ethics and disseminationThis study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres.Trial registration numberISRCTN22901977.
120 NHS 24 triage of the young adult with chest pain: an analysis of patient contacts in unscheduled care
Authors: Hodgins Peter , Guthrie Bruce , McMinn Megan 
Published: January 2021

Aims/Objectives/BackgroundUse of unscheduled care is increasing worldwide. In the UK access to services for symptoms not thought to be life-threatening is through a single telephone advice and triage service (NHS 24 in Scotland). Adults under 35 account for the largest cohort contacting this service. This study aimed to examine pathways of care in this population to inform areas for improvement to the triage process.Methods/DesignA retrospective, population study using the Scotland-wide Urgent Care Data Mart (UCD) 2015 to 2017. The UCD links data between unscheduled care services to form Continuous Urgent Care Pathways (CUPs). CUPs for those aged 15–34 years, whose initial contact was with NHS 24 and with ‘chest pain’ recorded as the call reason. Two outcomes were examined: admission to hospital, and admission to hospital with a ‘time-critical diagnosis’ defined as an admission with a discharge diagnosis of a condition that required urgent treatment.Abstract 120 Figure 1Results/ConclusionsA total of 102,822 CUPs initiated by a call to NHS24 with chest pain as the call reason in the period studied. 35.1% of calls were made by people living in the most deprived 20% of postcodes. The most common CUP pathway accounted for 37.6% and was an NHS 24 call followed by an attendance at Primary Care Out of Hours. 25.4% of calls were considered not to represent an urgent care need. The most frequent ICD-10 code was ‘chest pain, unspecified’, representing 7.2% of cases with an ICD-10 code, followed by ‘asthma, unspecified’ at 7.1%. All NHS24 dispositions were strongly associated with increased odds of admission compared to self-care advice. Home-visits were associated with the greatest odds of time-critical diagnosis.Chest pain is a symptom of concern for young people. Use of telephone triage is effective. 9060 CUPs result in a hospital admission, although many end with a non-specific diagnosis.
117 COVID-19 RCEM research summaries: taking the burden off busy clinicians
Authors: Reynard Charles , Jafar Anisa , Oliver Govind , Darbyshire Daniel , Prager Gabrielle , Naguib Mina , Carley Simon 
Published: January 2021

Aims/Objectives/BackgroundEntering lockdown on 23rd March 2020 due to the COVID-19 pandemic marked an unprecedented period for healthcare evidence. An exponential increase in published work, pre-prints, guidelines, online information portals and more, has been overwhelming especially when combined with the ever-changing local emergency department responses to COVID-19. Many research projects were either suspended in favour of clinical work or re-routed into pandemic-oriented studies. All the while, the gap between clinical providers and a mountain of information was growing. Our team developed a strategy to deliver the most pertinent evidence to those working in emergency medicine, taking some stress out this aspect of COVID-19 working.Methods/DesignEach week a search was conducted using PubMed of everything produced in the previous 7 days. The number of titles varied from approximately 800 to 2500. A 3 to 5 person team distilled titles and then reviewed abstracts for papers of importance and relevance to emergency medicine. Relevant and high impact journals were individually searched over the same time period. Summaries of the short-listed papers were produced and the weekly editorial team selected 5 for inclusion in the weekly RCEM Top 5 and others were combined for extra reading as part of a 2–3 weekly ‘Director’s Cut’.Results/ConclusionsThe RCEM Top 5 (at time of writing) has been run for 13 weeks. The summaries themselves were accessed by between 3000 and 6000 RCEM members/fellows each week. The work has also fed into online journal clubs and blogs (combined views of over 30,000) and has attracted interest from wider colleagues nationally and internationally to both join and even replicate the approach to other relevant areas. The positive feedback is best summarised in the following quote: ‘when I’m too mentally overcooked to do any reading on my own this helps me feel I am doing some keeping up. Please continue!’
71 Ultrasound directed reduction of Colles’ type distal radial fractures in ED (UDiReCT): a feasibility randomized controlled trial
Authors: Malik Hamza , Appelboam Andrew , Taylor Gordon , Wood Daryl , Knapp Karen 
Published: January 2021

Aims/Objectives/BackgroundWrist fractures are among the commonest injuries seen in the emergency department (ED). Around 25% of these injuries have Colles’ type fracture displacement and undergo manipulation in the ED. In the UK, these manipulations are typically done ‘blind’ without real time imaging and recent observational studies show that over 40% of the injuries go on to require surgical fixation (due to inadequate initial reduction or re-displacement). Point of care ultrasound has been used to guide and improve wrist fracture reductions but it’s effect on subsequent outcome is not established. We set up and ran the UK’s first randomised controlled feasibility trial comparing standard and ultrasound guided ED wrist fracture manipulations to test a definitive trial protocol, data collection and estimate recruitment rate towards a future definitive trial.Methods/DesignWe conducted a 1:1, single blind, parallel group, randomised controlled feasibility trial in two UK hospitals. Adults with Colles’ type distal radial fractures requiring manipulation in the ED were recruited by supervising emergency physicians supported by network research nurses. Participants were randomised to ultrasound directed fracture manipulation (intervention) or standard care with sham ultrasound (controls). The trial was run through Exeter Clinical Trials Unit and consent, randomisation and data collection conducted electronically in REDCap cloud. All participants were followed up at 6 weeks to record any surgical intervention and also underwent baseline and 3 month quality of life (EQ-5D-5L) and wrist function (Patient Rated Wrist Evaluation (PRWE) assessments.Results/ConclusionsWe recruited 47 patients in total, with 23 randomised to the interventional arm and 24 randomised to the control arm. We were able to follow up 100% of the patients for the 6 week follow up. Data analysis and results will be presented at the time of the conference.
292 Emergency airway management outside the operating room; a three year prospective service evaluation and quality improvement project
Authors: Horner Daniel , Daniels Benjamin , Murray Nicola , Allen Gareth , Baylis Claire 
Published: January 2021

Aims/Objectives/BackgroundEmergency airway management outside a controlled theatre environment has been previously associated with a high rate of adverse events. Several initiatives to improve safety (such as video laryngoscopy, checklists, simulation training etc..) have been studied in isolation.It remains unclear as to whether these interventions have been embedded in the Emergency Department (ED) and whether they offer cumulative marginal gains in safety.Methods/DesignA prospective 3-year service evaluation delivered at a major trauma and neurosciences centre between 2016 and 2019. We designed a rolling quality improvement program to mitigate procedural airway risk through collaborative multidisciplinary team (MDT) working, education and transparent metrics.PDSA cycles included documentary guidance (including flowcharts and checklists), high fidelity simulation training, equipment redesign, prefilled medications and mandatory reporting items (figure 1).Abstract 292 Figure 1Abstract 292 Figure 2Primary induction agents selected throughout the study periodAbstract 292 Figure 3Results/ConclusionsWe analysed prospectively collected data on 1181 intubation episodes outside a theatre environment over a 39 month period, of which 575 (48.7%) were performed out of hours and 635 (53.8%) were performed in the ED.Bedside consultant presence and periprocedural checklist use both showed a sustained increase during the study period. Use of ketamine and thiopentone as primary induction agents increased and decreased, respectively (figure 2). Cricoid pressure and video laryngoscopy (VL) utilisation rates remained relatively static throughout, as did a first pass success (FPS) rate of between 83.0 to 93.5%.Composite major complications (including sustained hypotension and/or critical hypoxia) were significantly reduced during the study period, as demonstrated via statistical process chart (SPC) mapping (figure 3).In conclusion, we found a quality improvement program to be associated with a sustained reduction in the risk of major complications following emergency airway management. This improvement was not explained by simple direct changes in procedural care, such as the use of VL or technique changes resulting in improved FPS, but may have been influenced by unknown confounding variables.