bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of network-derived metabolite clusters with prevalent type 2 diabetes among adults of Puerto Rican descent
Authors: Haslam Danielle E , Liang Liming , Wang Dong D , Kelly Rachel S , Wittenbecher Clemens , Pérez Cynthia M , Martínez Marijulie , Lee Chih-Hao , Clish Clary B , Wong David T W , Parnell Laurence D , Lai Chao-Qiang , Ordovás José M , Manson JoAnn E , Hu Frank B , Stampfer Meir J , Tucker Katherine L , Joshipura Kaumudi J , Bhupathiraju Shilpa N 
Published: August 2021

IntroductionWe investigated whether network analysis revealed clusters of coregulated metabolites associated with prevalent type 2 diabetes (T2D) among Puerto Rican adults.Research design and methodsWe used liquid chromatography-mass spectrometry to measure fasting plasma metabolites (>600) among participants aged 40–75 years in the Boston Puerto Rican Health Study (BPRHS; discovery) and San Juan Overweight Adult Longitudinal Study (SOALS; replication), with (n=357; n=77) and without (n=322; n=934) T2D, respectively. Among BPRHS participants, we used unsupervised partial correlation network-based methods to identify and calculate metabolite cluster scores. Logistic regression was used to assess cross-sectional associations between metabolite clusters and prevalent T2D at the baseline blood draw in the BPRHS, and significant associations were replicated in SOALS. Inverse-variance weighted random-effect meta-analysis was used to combine cohort-specific estimates.ResultsSix metabolite clusters were significantly associated with prevalent T2D in the BPRHS and replicated in SOALS (false discovery rate (FDR) <0.05). In a meta-analysis of the two cohorts, the OR and 95% CI (per 1 SD increase in cluster score) for prevalent T2D were as follows for clusters characterized primarily by glucose transport (0.21 (0.16 to 0.30); FDR <0.0001), sphingolipids (0.40 (0.29 to 0.53); FDR <0.0001), acyl cholines (0.35 (0.22 to 0.56); FDR <0.0001), sugar metabolism (2.28 (1.68 to 3.09); FDR <0.0001), branched-chain and aromatic amino acids (2.22 (1.60 to 3.08); FDR <0.0001), and fatty acid biosynthesis (1.54 (1.29 to 1.85); FDR <0.0001). Three additional clusters characterized by amino acid metabolism, cell membrane components, and aromatic amino acid metabolism displayed significant associations with prevalent T2D in the BPRHS, but these associations were not replicated in SOALS.ConclusionsAmong Puerto Rican adults, we identified several known and novel metabolite clusters that associated with prevalent T2D.
US Army basic combat training alters the relationship between body mass index and per cent body fat
Authors: Foulis Stephen A , Hughes J M , Spiering B A , Walker L A , Guerriere K I , Taylor K M , Proctor S P , Friedl K E 
Published: August 2021

Introduction/backgroundAs a proxy for adiposity, body mass index (BMI) provides a practical public health metric to counter obesity-related disease trends. On an individual basis, BMI cannot distinguish fat and lean components of body composition. Further, the relationship between BMI and body composition may be altered in response to physical training. We investigated this dynamic relationship by examining the effect of US Army basic combat training (BCT) on the association between BMI and per cent body fat (%BF).MethodsBMI and %BF were measured at the beginning (week 1) and end (week 9) of BCT in female (n=504) and male (n=965) trainees. Height and weight were obtained for BMI, and body composition was obtained by dual X-ray absorptiometry. Sensitivity and specificity of BMI-based classification were determined at two BMI thresholds (25 kg/m2and 27.5 kg/m2).ResultsA progressive age-related increase in fat-free mass index (FFMI) was observed, with an inflection point at age 21 years. In soldiers aged 21+, BMI of 25.0 kg/m2predicted 33% and 29% BF in women and 23% and 20% BF in men and BMI of 27.5 kg/m2predicted 35% and 31% BF in women and 26% and 22% BF in men, at the start and end of BCT, respectively. Sensitivity and specificity of BMI-based classification of %BF were poor. Soldiers below BMI of 20 kg/m2had normal instead of markedly reduced %BF, reflecting especially low FFMI.ConclusionsBCT alters the BMI–%BF relationship, with lower %BF at a given BMI by the end of BCT compared with the beginning, highlighting the unreliability of BMI to try to estimate body composition. The specific BMI threshold of 25.0 kg/m2, defined as‘overweight’, is an out-of-date metric for health and performance outcomes. To the extent that %BF reflects physical readiness, these data provide evidence of a fit and capable military force at BMI greater than 25.0 kg/m2.
Prevalence of sarcopenia in older Chinese adults: a systematic review and meta-analysis
Authors: Xin Caihong , Sun Xin , Lu Li , Shan Ling 
Published: August 2021

ObjectiveThis meta-analysis was conducted to estimate the overall prevalence of sarcopenia in older Chinese adults.DesignSystematic review and meta-analysis.ParticipantsA literature research was conducted using the PubMed, Web of Science, China National Knowledge Infrastructure, CQVIP and Wanfang databases. The following search terms in the abstract were used: “sarcopenia” in combination with the terms “prevalence,” “epidemiology” and “China.” All studies published from January 2010 to November 2020 were included. The random-effect model was used to estimate the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia at a 95% CI was also calculated using different criteria for defining sarcopenia.Primary outcome measuresThe overall prevalence of sarcopenia in older Chinese adults.ResultsIn total, 23 articles were included in this meta-analysis involving 21 564 participants. On the basis of the Asian Working Group for Sarcopenia criterion, the overall prevalence of sarcopenia among the elderly in China was 14% (95% CI 11% to 18%); the prevalence was higher in Chinese women than in men (15% vs 14%).ConclusionsThis systematic review is the first estimation of the pooled prevalence of sarcopenia in older Chinese adults. Our results suggest that China has a large number of patients with sarcopenia. These findings would be useful for sarcopenia prevention in China. There is a high degree of heterogeneity, and although there are a large number of cases and could be an emerging public health issue, more research is required to make these claims.PROSPERO registration numberCRD42020223405.
The road to hell is paved with good intentions: the experience of applying for national data for linkage and suggestions for improvement
Authors: Taylor Julie A , Crowe Sonya , Espuny Pujol Ferran , Franklin Rodney C , Feltbower Richard G , Norman Lee J , Doidge James , Gould Doug William , Pagel Christina 
Published: August 2021

BackgroundWe can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging.ObjectiveWe describe our experience of the data application and linkage process for our study ‘LAUNCHES QI’, and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements.FindingsThe study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit’s capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process.ConclusionsThe current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.
Utilisation of remote capillary blood testing in an outpatient clinic setting to improve shared decision making and patient and clinician experience: a validation and pilot study
Authors: Nwankwo Lisa , McLaren Kate , Donovan Jackie , Ni Zhifang , Vidal-Diaz Alberto , Loebinger Michael , Morrisey Alice , Igra Adam , Shah Anand 
Published: August 2021

BackgroundIn a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.ObjectivesThis study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.MethodsA single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.Results117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.ConclusionsRemote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.
EP13 Perceptions and experiences of residents and relatives of emergencies in care homes: systematic review and meta-synthesis
Authors: Laparidou Despina , Curtis Ffion , Udayangani Jayawickrama Withanage Iresha , Weligamage Dedunu , Ortega Marishona , Siriwardena Aloysius Niroshan 
Published: August 2021

BackgroundMedical emergencies in care homes, both residential and nursing care homes, are common and costly, often resulting in calls to an out-of-hours general practitioner (GP) or Emergency Medical Services (EMS). Ambulance attendance frequently results in conveyance to hospital and the concomitant high costs and risks of, often prolonged, hospitalisation. Previous reviews have focussed on various stakeholder perceptions of transfer to hospital. The aim of this systematic review was to provide a comprehensive synthesis of the perceptions and experiences of care home residents and their family members, who have experienced medical emergencies in a care home setting.MethodsWe searched five electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review.ResultsThe search strategy identified 6,140 citations. After removing duplicates and excluding citations based on title and abstract, and full-text screening, ten studies from four countries (Australia, Canada, UK, and US) were included in the review and meta-synthesis. All included studies were considered of acceptable quality. Through an iterative approach, we developed six analytical themes. 1. Infrastructure and process requirements in care homes to prevent and address emergencies; 2. The decision to transfer to hospital – a perfect storm; 3. Challenges of transfer and hospitalisation for older patients; 4. Good communication vital for desirable outcomes; 5. Legal, regulatory and ethical concerns; and 6. Trusting relationships enabled residents to feel safe.ConclusionsThe emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care. Building trusting relationships underpinned by good communication and attention to ethical practice were also identified as important factors.
PP14 An investigation of ambulance clinical recommendations for the management of obstetric emergencies in Australia and New Zealand
Authors: Flanagan Belinda , Pearce James , Barr Nigel , Eastwood Kathryn 
Published: August 2021

BackgroundVarious international studies have recognised that paramedics receive limited obstetric training and historically lack confidence in managing obstetric and neonatal emergencies. This lack of confidence, deficits in training and limited exposure to such cases may be sustained by absent, dated or insufficient clinical guidance provided by the employer. Clinical guidelines are an essential tool and cognitive aid to provide guidance when formulating an appropriate treatment plan, however paramedics have reported the use of varying and dated practices and procedures that have the potential to cause significant patient harm. The aim of this study was to conduct a qualitative textual/document analysis on five publicly available obstetric guidelines published by ambulance services in Australia and New Zealand.MethodPublicly available electronic guidelines from Australian and New Zealand ambulance jurisdictions were imported into a custom designed data collection frame for comparison. This frame focused on five specific areas of obstetric presentations. Guideline quality was measured against a recognised national standard for the development and publication of clinical guidelines. Information and recommendations presented were compared against expert advice provided by the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG), Word Health Organization (WHO), state health clinical guidelines and systematic reviews.ResultsAll ambulance service guidelines reviewed failed to meet the national standards for the development and publication of clinical guidelines in the area of transparency and grading of evidence. Some advice within the guidelines was found to be inconsistent, not supported by evidence, have the potential to cause harm or be absent. Some were found to be heavily reliant on hospital-based mnemonics that were either not ambulance specific or contained advice that was outside a paramedic scope of practice.ConclusionThis study has identified inconsistent recommendations and highlighted conflicting and inadequate advice for paramedics when managing obstetric and neonatal emergencies.
PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation
Authors: Edwards Michelle , Cooper Alison , Davies Freya , Stevens Andrew Carson , Edwards Adrian , Hughes Thomas , Snooks Helen , Anderson Pippa , Porter Alison , Evans Bridie , Dale Jeremy , Cooke Matthew , Hibbert Peter , Siriwardena Aloysius Niroshan 
Published: August 2021

BackgroundRecent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects onpatient flow(waiting times and length of stay in the ED); andsafestreaming outcomes.MethodsWe used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.ResultsWe identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.ConclusionsWe identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.
PP22 How do emergency staff communicate with patients during resuscitation?
Authors: Joss Karyn , Lloyd Adam , Clegg Gareth 
Published: August 2021

BackgroundClinical communication plays a key role in conveying compassion between individuals. Positive non-verbal communication (NVC) has been shown to encourage connectedness and improve patient outcomes – i.e. reducing pain and anxiety – in a range of conditions, including major trauma. Whilst little is understood about how staff utilise NVC in the resuscitation room, quality of interpersonal interactions has been shown to be the largest overall predictor of patient satisfaction within the Emergency Department (ED). Existing studies within the ED highlight patient experiences of feeling ‘isolated’, with their distress being ‘insensitively disregarded’ by staff, hence further research is required to improve patient experience.MethodsThis study utilised the video auditing system within the ED of Edinburgh’s Royal Infirmary to observe how emergency staff employed NVC with conscious patients across (n=15) resuscitation cases. Results were fed back to clinical staff, with suggestions for developing compassion awareness. Mixed method qualitative and quantitative analyses were employed to assess positive and negative staff NVC behaviours and evaluate how these appeared to influence patient experience. Several existing matrices for measuring staff non-technical performance informed design of a novel system for scoring five key aspects of clinical NVC: touch, eye contact, body language, proximity and patient exposure.ResultsThis study highlights significant variation in how emergency staff convey compassion to patients during resuscitation. Staff members exhibited a range of positive and negative NVC behaviours, which were occasionally at odds with verbal cues given. Patterns of communication appeared related to members’ roles within the emergency team, with medical and nursing staff exhibiting different strengths.ConclusionsOur findings are consistent with the idea that acts of compassion are ‘emotional labour’, underlining the need for staff education surrounding positive NVC, as well as increased workplace support. We suggest environmental level strategies including incorporation of a specifically designed ‘compassionate care’ toolkit into handover/pre-arrival checklists.
PP27 Features of emergency medical system calls that facilitate or inhibit call-taker recognition that a patient is in, or at risk of, cardiac arrest: a systematic mixed studies review
Authors: Kirby Kim , Voss Sarah , Bird Emma , Benger Jonathan 
Published: August 2021

AimTo identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest.MethodsAll study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach.ResultsTwenty-five studies were included in the review. ‘Recognition studies’ involving patients already in out-of-hospital cardiac arrest dominated this SMSR and challenges associated with recognition of out-of-hospital cardiac arrest were apparent. Four main themes were identified: Recognising abnormal/agonal breathing during the emergency call, Managing the emergency call, Emotional distress, Patient’s colour.ConclusionA dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA.