bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study
Authors: Jürisson Mikk , Pisarev Heti , Uusküla Anneli , Lang Katrin , Oona M , Kalda Ruth 
Published: October 2021

ObjectivesPrevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia.DesignA population-based cross-sectional study, using administrative data.SettingData were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions.ParticipantsThe Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance.Primary and secondary outcome measuresPrevalence and 95% CIs for MM stratified by age group and sex.ResultsNearly half (49.1%) of the individuals (95% CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%–3.6%) in the youngest (0–24 years) to as high as 80.4% (79.4%–81.3%) in the oldest (≥85 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95% CI 34.7 to 35.0) than men (24.4%, 95% CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%).ConclusionsHypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.
How is family health history discussed in routine primary healthcare? A qualitative study of archived family doctor consultations
Authors: Filoche Sara , Stubbe Maria H , Grainger Rebecca , Robson Bridget , Paringatai Karyn , Wilcox Phil , Jefferies Regina , Dowell Anthony 
Published: October 2021

ObjectivesFamily health history underpins genetic medicine. Our study aimed to explore language and patterns of communication relating to family health history observed in interactions between general practitioners (GPs) and their patients within routine primary care consultations.DesignSecondary analysis of patient and GP routine consultation data (n=252).ParticipantsConsultations that included ‘family health history’ were eligible for inclusion (n=58).Primary outcomesA qualitative inductive analysis of the interactions from consultation transcripts.Results46/58 conversations about family health history were initiated by the GP. Most discussions around family history lasted for between approximately 1 to 2 min. Patients were invited to share family health history through one of two ways: non-specific enquiry (eg, by asking the patient about ‘anything that runs in the family’); or specific enquiry where they were asked if they had a ‘strong family history’in relation to a particular condition, for example, breast cancer. Patients often responded to either approach with a simple no, but fuller negative responses also occurred regularly and typically included an account of some kind (eg, explaining family relationships/dynamics which impeded or prevented the accessibility of information).ConclusionsFamily health history is regarded as a genetic test and is embedded in the sociocultural norms of the patient from whom information is being sought. Our findings highlight that it is more complex than asking simply if ‘anything’ runs in the family. As the collection of family health history is expected to be more routine, it will be important to also consider it from sociocultural perspectives in order to help mitigate any inequities in how family history is collected, and therefore used (or not) in a person’s healthcare. Orientating an enquiry away from ‘anything’ and asking more specific details about particular conditions may help facilitate the dialogue.
Representative estimates of COVID-19 infection fatality rates from four locations in India: cross-sectional study
Authors: Cai Rebecca , Novosad Paul , Tandel Vaidehi , Asher Sam , Malani Anup 
Published: October 2021

ObjectivesTo estimate age-specific and sex-specific mortality risk among all SARS-CoV-2 infections in four settings in India, a major lower-middle-income country and to compare age trends in mortality with similar estimates in high-income countries.DesignCross-sectional study.SettingIndia, multiple regions representing combined population >150 million.ParticipantsAggregate infection counts were drawn from four large population-representative prevalence/seroprevalence surveys. Data on corresponding number of deaths were drawn from official government reports of confirmed SARS-CoV-2 deaths.Primary and secondary outcome measuresThe primary outcome was age-specific and sex-specific infection fatality rate (IFR), estimated as the number of confirmed deaths per infection. The secondary outcome was the slope of the IFR-by-age function, representing increased risk associated with age.ResultsAmong males aged 50–89, measured IFR was 0.12% in Karnataka (95% CI 0.09% to 0.15%), 0.42% in Tamil Nadu (95% CI 0.39% to 0.45%), 0.53% in Mumbai (95% CI 0.52% to 0.54%) and an imprecise 5.64% (95% CI 0% to 11.16%) among migrants returning to Bihar. Estimated IFR was approximately twice as high for males as for females, heterogeneous across contexts and rose less dramatically at older ages compared with similar studies in high-income countries.ConclusionsEstimated age-specific IFRs during the first wave varied substantially across India. While estimated IFRs in Mumbai, Karnataka and Tamil Nadu were considerably lower than comparable estimates from high-income countries, adjustment for under-reporting based on crude estimates of excess mortality puts them almost exactly equal with higher-income country benchmarks. In a marginalised migrant population, estimated IFRs were much higher than in other contexts around the world. Estimated IFRs suggest that the elderly in India are at an advantage relative to peers in high-income countries. Our findings suggest that the standard estimation approach may substantially underestimate IFR in low-income settings due to under-reporting of COVID-19 deaths, and that COVID-19 IFRs may be similar in low-income and high-income settings.
Efficacy of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in young children with bilateral cerebral palsy (GMFCS III-IV) in a low and middle-income country: protocol of a randomised controlled trial
Authors: Sogbossi Emmanuel Segnon , Sotindjo Adon Solange , Adjagodo Leontine , Dossou Solange , Dakè Hyppolite , Ebner-Karestinos Daniela , Araneda Rodrigo , Saussez Geoffroy , Paradis Julie , Kpadonou Toussaint G , Bleyenheuft Yannick 
Published: October 2021

IntroductionCerebral palsy (CP) is highly prevalent in sub-Saharan Africa, where clinically-based studies have shown a considerable over-representation of the severe bilateral subtype. However, children’s access to rehabilitation care is limited by many local factors, notably the lacking of rehabilitation services, insufficient knowledge of caregivers and financial constraints. In such a context there is an urgent need for studies of the evidence-based rehabilitation approach. Here, we describe the protocol of a randomised controlled study to investigate the efficacy of Hand-Arm Bimanual Intensive Therapy Including the Lower Extremities (HABIT-ILE) in young children with bilateral CP in Benin Republic, a representative low and middle-income country of western Africa.Methods and analysisForty children with bilateral CP aged between 24 and 59 months and with level III-IV in the gross motor function classification will be randomised to either a high intensity conventional therapy or HABIT-ILE therapy. Both therapies will be delivered as a day-camp model over 2 weeks to a total of 50 hours (5 hours per day). The assessor-blinded primary outcomes will include the gross motor function measure and both hands assessment. Secondary outcomes will be the adapted version of the ACTIVLIM-CP questionnaire, the Canadian Occupational Performance Measure, and a perception of CP interview form. Children will be assessed at baseline, after intervention and at 6-week follow-up. A 2 (group)×3 (test sessions) repeated analysis of variance will evaluate changes after the interventions.Ethics and disseminationThis study has been approved by the ethics committee of the rehabilitation department of the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, Benin (approval decision: N°01–2019/MS/CNHU-HKM/CEI/CUMPR). All participants’ parents/caregivers will provide their written informed consent. Data will be managed with confidentiality.Trial registration numberPACTR201911894444879.
Serum membrane osmotic pressure is lower in patients with shock associated with systemic inflammation
Authors: Clegg Gareth 
Published: October 2021

IntroductionShock syndromes are a common feature of critically ill patients presenting to the Emergency Department. We suggest that the lack of consensus around the optimum strategy for fluid resuscitation exists because previous work has not taken into account the pathophysiological state of the microcirculation in shocked patients. Aetiologies characterised by marked systemic inflammation – such as sepsis or anaphylaxis – are likely to have greater initial capillary leak than those caused by haemorrhage or sudden cardiac pump failure. Membrane osmotic pressure (MOP) is a marker of capillary leak, with acute changes reflecting the loss of large circulating molecules from the intravascular space. We hypothesise that in patients with shock syndromes osmolality could provide a tool for guiding initial resuscitation.MethodsIn this prospective observational study we enrolled 55 non-pregnant patients over 16 years of age with a mean arterial pressure of 2.9 mmol/l, or shock index (heart rate/systolic blood pressure) >0.9 presenting to our Emergency Department between 2 February, 2010 and 9 September, 2010. MOP, and serum levels of the pro-inflammatory cytokine interleukin-8 were measured 24 h after presentation.ResultsWe compared the MOP in those patients with levels of IL-8 consistent with significant systemic inflammation (>100 pg/ml) to those with lower levels. MOP was significantly lower in patients with greater systemic inflammation (18.58 (CI 17.03 to 20.12) CF 21.24 (CI 20.03 to 22.44) p=0.016).DiscussionOur results are consistent with the hypothesis that patients whose shock is associated with marked systemic inflammation have a greater degree of capillary leak leading to an acute drop in serum osmotic pressure.
Comparing the prognostic performance of S100B with prognostic models in traumatic brain injury
Authors: Lesko Mehdi 
Published: October 2021

IntroductionThere are currently two prognostic tools available for predicting outcome in traumatic brain injury (TBI): prognostic models combining clinico-demographic characteristics of patients for outcome prediction and brain injury biomarkers (eg, S100B).ObjectiveTo identify which method has better prognostic strength.MethodsWe analysed data from 100 TBI patients, all of whom were admitted to the intensive care unit and had venous S100B levels recorded at 24-h after injury. TBI prognostic models A and B, constructed in Trauma Audit and Research Network (TARN)1, were run on the dataset and then S100B was added as an independent predictor to each model. Furthermore, another model was developed containing only S100B and subsequently, other important TBI predictors were added to assess their ability to enhance the predictive power of this model. The outcome measures were survival and favourable outcome at 3 months.ResultsAmong all the prognostic variables (including age, cause of injury, Glasgow Coma Scale, pupillary reactivity, Injury Severity Score (ISS) and CT classifications); S100B has the highest predictive strength on multivariate analysis. No difference between performance of prognostic models or S100B in isolation was observed. Addition of S100B to the prognostic models improves the performance (eg, area under the roc curve (AUC), R2 Nagelkerke and classification accuracy of TARN model A to predict survival increase from 0.64, 0.08 and 71% to 0.72, 0.20 and 74.7% respectively). Similarly, the predictive power of S100B increases by adding other predictors to S100B (eg, AUC (0.69 vs 0.78), R2 Nagelkerke (0.15 vs 0.30) and classification accuracy (73% vs 77%) for survival prediction).ConclusionS100B appears to be the strongest prognostic variable in TBI. A better prognostic tool than those which are currently available may be a combination of both clinicodemographic predictors with S100B.
The introduction and impact of a “hot” qualitative mortality reporting system for patients dying within 24 h of admission
Authors: Turner Chris 
Published: October 2021

IntroductionIn late 2008 the consultant body at Stafford Hospital Emergency Department introduced and implemented a rapid qualitative review of all patients dying within 24 h of admission to Stafford Hospital. The aim was to identify recurrent themes and implement systematic change to address them.MethodNotes are delivered within 24 h of death to the acute and emergency medicine consultants. Reviews are based on the notes of staff delivering care an supplemented by additional interviews where clarification was required. The aim is to conduct those reviews within days of death. The rapid nature of these reviews means it is often possible to speak with staff while their memory of events is clear.AnalysisCodes and concepts were derived from this and recurrent themes identified. These themes were then investigated and, where possible, a systematic change was introduced to reduce the possibility of this happening again. These issues were reported to departmental governance bimonthly. The following month's mortality data was reviewed with a specific check on the issues that had previously been noted to be a problem. Audits around the solutions put in place were conducted.ResultsProblems identified included unreported ECGs, unrecognised sepsis, inappropriate level Drs assessing the sickest patients and inappropriate cardiopulmonary resuscitation. Where issues required input from other departments or services partnerships were formed and we worked in tandem to attempt to resolve systems failures. The outcome of this system has been the introduction of a variety of novel solutions to patient care problems (see other abstract presentations) and a reduction in the HSMR of emergency patients at Stafford Hospital from 150 to 60 for emergency admissions.Clinical bottom linequalitative mortality reporting when performed by senior clinicians has the potential to identify systematic failings and significantly improve quality of care.
Nursing satisfaction with the introduction of the Liverpool care pathway to emergency medicine
Authors: Strachan Stuart 
Published: October 2021

IntroductionThe Liverpool Care Pathway (LCP) has been effective in bringing a framework to the provision of care for the dying patient. Over the last 10 years the LCP has been adapted to assist in clinical areas that were not traditionally thought of as providing palliative care. In 2005 it was adapted and developed to reflect the specialised and unique environment of the Emergency Department (ED).MethodsThis qualitative study collated the response to an anonymous web based questionnaire and focus group discussions with ED nursing staff. The groups facilitated discussion on day to day nursing perception and satisfaction with the LCP. The results were analysed using thematic analysis.ResultsCommon themes were identified in the questionnaire's results and focus groups. The staff believe that the adapted LCP provides a complete framework for delivery of care to the dying patient. They felt able to utilise their clinical judgment and that their opinions were valued within the LCP. Following implementation the staff felt a closer working relationship when supporting and communicating with the patient and their family.ConclusionNursing satisfaction improved with the provision of care the LCP enabled them to provide. The development of a specifically tailored pathway was described as being enabling. The focus groups also felt that the knowledge base was good, however further updates and formalised training would increase the overall understanding within the department. This adapted LCP is regularly reviewed and updated to ensure the highest level of patient care, resulting in staff having the opportunity to influence the care they are providing. The feedback and review allows continual development to insure it meets the needs of the busy environment of Emergency Medicine (EM). This regular review and feedback will allow the model of the LCP in EM to be transferred to other ED's throughout the UK.
Back to basics – ECG impedance analysis for CPR quality control and feedback after out-of-hospital cardiac arrest: a pilot study
Authors: Lyon Richard 
Published: October 2021

BackgroundOut-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality. Survival from OHCA depends on good quality cardiopulmonary resuscitation from ambulance personnel. The ‘time on the chest’ and interruption time for defibrillation have recently been shown to be pivotal to survival. Electrocardiograph impedance analysis software allows retrospective quality control and feedback to ambulance crews after a resuscitation attempt. Telemetry and analysis of prehospital resuscitation episodes has not yet been employed in the UK.AimsTo establish the feasibility of using impedance software for prehospital resuscitation quality control and to gain baseline data on prehospital resuscitation practice in the Lothians region of Scotland.MethodsProspective, observational 3-month pilot study. Broadband modems were placed on ambulance defibrillators and configured on the Lifenet (Physio Control) data network. After a resuscitation attempt the attending EMS crew was asked to telemetry the resuscitation trace to a research computer. The impedance trace was then analysed using computer software (Codestat-Physio Control) and a report on the resuscitation attempt generated.Results17 OHCA were included in pilot. All EMS crews agreed to use telemetry. Ten cases met the target of over 70% compression time. Only two cases met the target of a compression rate of 90–110 /min. The defibrillator was used in manual mode in the majority of cases. The mean time from cessation of chest compressions to delivery of defibrillatory shock was 46s.ConclusionTelemetry of ECG impedance analysis is a straightforward, accurate, accepted method of assessing quality of prehospital resuscitation by ambulance personnel. Baseline data from our region suggests that the quality of advanced life support could be improved by focusing on basic elements of resuscitation. Using software-generated resuscitation reports could be useful for ambulance personnel feedback and monitoring effectiveness of training programmes. Further research is warranted on the widespread use of this technique.
The role of biochemical markers in the identification of intracranial pathology following minor head injury: a systematic review and meta-analysis
Authors: Pickering Alastair 
Published: October 2021

IntroductionBiochemical markers may have a role to play as objective tools for ruling out significant complications following minor head injury, while reducing the rate of ‘unnecessary’ CT scans. This study aimed to systematically identify and analyse the data from studies investigating biochemical markers as a screening tool for intracranial injury on CT.MethodsPotentially relevant studies were identified by an electronic search of key databases including MEDLINE, EMBASE and CINAHL. Papers in English were included if they consisted of a cohort of more than 20 patients with more than 50% having suffered a minor head injury (GCS 13–15). Studies must describe the use of a biochemical marker to screen for the identification of intracranial or neurosurgical injury.ResultsA total of 7800 citations were identified of which 13 were included. Ten of these were investigating the role of protein S100B, two Neuron-Specific Enolase and one for dopamine and epinephrine. No useful, validated data could be extracted from the non-S100B studies. Mild head injury (GCS of 13–15) was generally consistently defined and included mild symptoms. All recruited patients received the reference standard of CT scan, mostly within 6 h of injury, along with the index test. Analysis techniques varied but are now practical for real-time results in the ED. Meta-analysis of these pooled data gives a sensitivity of 97.7% (95% CI 95.1% to 99.3%) and specificity of 43.4% (95% CI 31.4% to 56.2%) with a negative likelihood ratio of 0.053 (95% CI 0.015 to 0.117).DiscussionThere is a mounting body of evidence to support the addition of protein S100B as a triage tool for CT, in minor head injury patients, within 4 h of their injury. While the quality of studies so far is good, results are mixed and the marker needs further testing in conjunction with clinical decision rules.
Creating safer decision support systems for paediatric emergency care: the Paeds ED project
Authors: Samie Haidar 
Published: October 2021

IntroductionPaediatric emergency care requires precision in prescribing but this can be prone to error. Traditional ‘aide memoires’ for resuscitation of ill and injured children have limitations. We identified a need to develop a clinical decision support system (CDSS) that could be more accurate and replace these more traditional approaches.ObjectiveTo describe the development of a novel application (Paeds ED) designed to support clinicians making real time calculations in resuscitation of critically ill and injured children.MethodsThe iPhone platform was chosen to develop an application that would meet the needs of emergency medicine physicians managing certain categories of ill and injured children. Key time dependent emergency conditions were identified. An iterative development cycle was used, structured to address accuracy, reliability, interactivity and rapidity of accessing key information.ResultsThe Paeds ED decision aid contains an age to weight converter and drug formulary list. The age to weight conversions are based on the WHO 50th percentile tables. Once the user enters the age or weight the application is able to construct a formulary list for that patient. The formulary can be accessed directly or by a modular interface which is situation specific using standard internationally recognised resuscitation algorithms. The application was launched onto the Apple store for purchase under the terms of a ‘not for profit’ basis. A total of over 16 000 downloads of the two main applications have occurred in 50 different countries worldwide in the first 10 months since launch. Reviews have rated the application as being 4+ out of 5.ConclusionsWe have developed a CDSS application designed for use by staff involved in the management of critically ill and injured children. The Paeds ED application provides rapidity of accessing key information in acute situations and helps create safer working practices in emergency care.