bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observational study investigating the prevalence of asymptomatic stage B heart failure in patients with type 2 diabetes who are not known to have coronary artery disease
Authors: Oo Mon Myat , Tan Chung Zhen Isaiah , Ng Kee Seong , Tan Kok Leng , Tan Alexander T B , Vethakkan Shireene Ratna , A/L Ratnasingam R Jeyakantha , Chee Kok Han 
Published: January 2021

ObjectiveTo identify the prevalence of stage B heart failure (SBHF) in patients with type 2 diabetes mellitus (T2DM) with no history of cardiovascular disease (CVD).DesignObservational study.SettingA single-centre study in which eligible patients were recruited from T2DM clinic. Following consent, patients completed a questionnaire and underwent physical examinations. Patients had blood drawn for laboratory investigations and had a transthoracic echocardiography.ParticipantsA total of 305 patients who were not known to have CVD were recruited. Patients with deranged liver function tests and end stage renal failure were excluded.Main outcome measuresEchocardiographic parameters such as left ventricular ejection fraction, left ventricular mass index (LVMI), left ventricular hypertrophy, left atrial enlargement and diastolic function were examined.ResultsA total of 305 patients predominantly females (65%), with mean body mass index of 27.5 kg/m2 participated in this study. None of them had either a history or signs and symptoms of CVD. Seventy-seven percent of patients had a history of hypertension and 83% of this study population had T2DM for more than 10 years. Mean HbA1c of 8.3% was recorded. Almost all patients were taking metformin. Approximately, 40% of patients were on newer anti-T2DM agents such as sodium-glucose cotransporter-2 and dipeptidyl peptidase 4 inhibitors. Fifty-seven percent (n=174) of the study population had SBHF at the time of study: diastolic dysfunction, increased LVMI and increased left atrial volume index (LAVI) were noted in 51 patients (17%), 128 patients (42%) and 98 patients (32%), respectively. Thirty-seven patients (12%) had both increase LVMI and LAVI.ConclusionOur study has revealed a high prevalence of SBHF in T2DM patients without overt cardiac disease in Malaysia that has one of the highest prevalence of TDM in the world.
COVID-19 and healthcare workers: a rapid systematic review into risks and preventive measures
Authors: Gross J Valérie , Mohren Judith , Erren Thomas C 
Published: January 2021

ObjectiveThe COVID-19 pandemic is demanding for occupational medicine and for public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front lines, we must create safe work environments through comprehensive risk assessments, evaluation and effective implementation of counter-measures. We ask: ‘What does current literature report on health risks at workplaces regarding COVID-19?’ and ‘What do current studies report on the effectiveness of enacted preventative recommendations?’MethodsAs a snapshot of early HCW research, on 26 April 2020, we conducted a rapid systematic literature search in three databases (PubMed, Web of Science and PsycInfo) for COVID-19-related health outcomes and preventive measures in healthcare-associated workplaces.Results27 studies were identified as relevant for exploring the risk of infection, 11 studies evaluated preventive measures. The studies described that SARS-CoV-2 impacts significantly on HCW’s health and well-being, not only through infections (n=6), but also from a mental health perspective (n=16). 4 studies reported indirect risks such as skin injuries, one study described headaches to result from the use of personal protective equipment. Few studies provided information on the effectiveness of prevention strategies. Overall, most studies on health risks as well as on the effectiveness of preventive measures were of a moderate-to-low quality; this was mainly due to limitations in study design, imprecise exposure and outcome assessments.ConclusionsDue to widespread exposure of HCW to SARS-CoV-2, workplaces in healthcare must be as safe as possible. Information from HCW can provide valuable insights into how infections spread, into direct and indirect health effects and into how effectively counter-measures mitigate adverse health outcomes. However, available research disallows to judge which counter-measure(s) of a current ‘mix’ should be prioritised for HCW. To arrive at evidence-based cost-effective prevention strategies, more well-conceived studies on the effectiveness of counter-measures are needed.
Estimating under-reporting of COVID-19 cases in Indian states: an approach using a delay-adjusted case fatality ratio
Authors: Unnikrishnan Jayakrishnan , Mangalathu Sujith , Kutty Raman V 
Published: January 2021

ObjectivesThe COVID-19 pandemic has spread to all states in India. Due to limitations in testing coverage, the true extent of the spread may not be fully reflected in the reported cases. In this study, we obtain time-varying estimates of the fraction of COVID-19 infections reported in the different states.MethodsFollowing a methodology developed in prior work, we use a delay-adjusted case fatality ratio to estimate the true fraction of cases reported in different states. We also develop a delay adjusted test positivity estimation method and study the relationship between the estimated test positivity rate for each state and the estimated fraction of cases reported.SettingWe apply this method of analysis to all Indian states reporting at least 100 deaths as of 10 October 2020.ResultsOur analysis suggests that delay-adjusted case fatality ratios observed in different states range from 0.47% to 3.55%. The estimated fraction of cases reported in different states ranges from 39% to 100% for an assumed baseline case fatality ratio of 1.38%, from 18.6% to 100% for an assumed baseline case fatality ratio of 0.66%, and from 2.8% to 19.7% for an assumed baseline case fatality ratio of 0.1%. We also demonstrate a statistically significant negative relationship between the fraction of cases reported in each state and the testing positivity rate.ConclusionsThe estimates provide a means to quantify and compare the trends of reporting and the true level of current infections in different states. This information may be used to guide policies for prioritising testing in different states, and also to analyse the time-varying effects of different quarantine measures adopted in different states.
Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study
Authors: Harry Melissa , Woehrle Theo , Renier Colleen , Furcht Margaret , Enockson Michelle 
Published: January 2021

ObjectivesTo evaluate the predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled nursing facilities, including by diagnostic group (trauma injury, major lower joint replacement/reattachment, spinal fusion excluding cervical), as well as assess the effect of the short forms on 30-day inpatient readmissions.DesignRetrospective, observational cohort study of electronic health record data.SettingFive hospitals in a multistate, integrated healthcare system serving a large, rural US population.ParticipantsThe population-based adult (age ≥18) sample of acute care hospitalised patients receiving rehabilitation services included 10 316 patients with 12 314 hospital admissions from the year prior to 6-Clicks implementation (1 June 2015–31 May 2016) (pre-6-Clicks cohort) and 10 931 patients with 13 241 admissions from the year after 6-Clicks implementation (1 January 2017–31 December 2017) (post-6-Clicks cohort). Patients were admitted for major lower joint replacement/reattachment, spinal fusion excluding cervical, trauma injury or another reason.InterventionOccupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort.Primary and secondary outcomesDischarge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions.ResultsAreas under the receiver operating characteristic curve were 0.82–0.92 (daily activity) and 0.87–0.94 (basic mobility) for discharge to home or skilled nursing facilities, with trauma and spinal fusion patients having the highest values. Daily activity and basic mobility standardised positive and negative predictive values were highest for the three diagnostic groups compared with the full study sample. Few significant differences in 30-day readmissions were seen between pre- and post-6-Clicks cohorts.Conclusions6-Clicks performed well when distinguishing between discharge home or skilled nursing facilities, especially by diagnostic group, supporting use by occupational and physical therapists in discharge planning. Future research could assess where additional intervention or training may reduce 30-day readmissions.
Violence-related deaths among people released from incarceration: protocol for a systematic review
Authors: Willoughby Melissa , Young Jesse T , Spittal Matthew J , Borschmann Rohan , Janca Emilia K , Kinner Stuart A 
Published: January 2021

IntroductionYoung people and adults released from incarceration have a risk of dying from violence that far exceeds that in the general population. Despite this, evidence regarding the incidence, elevated risk and predictive factors for violence-related deaths after release have not yet been synthesised. This information is important to inform the development of evidence-based approaches to effectively prevent deaths from violence in this population. This systematic review will synthesise the literature examining the crude mortality rates (CMRs), standardised mortality ratios (SMRs) and predictive factors for violence-related deaths among people released from incarceration.Methods and analysisWe searched key electronic health, social science and criminology databases (MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, CINCH, Criminal Justice Abstracts) for peer-reviewed cohort studies published in English on 14thSeptember 2020. Our primary outcome of interest is violence-related deaths occurring in the community following release from incarceration. We will not restrict study eligibility by year of publication or age of participants. The Methodological Standard for Epidemiological Research (MASTER) scale will be used to assess the quality of included studies. If there are sufficient studies and homogeneity between studies, we will conduct meta-analyses to calculate pooled estimates of CMRs, SMRs or predictive factors for violence-related deaths. If there is a sufficient number of included studies, meta-regression will be conducted to examine the influence of subgroups and methodological factors on the CMRs, SMRs or predictive factors. If the studies do not report sufficient data, or if there is substantial heterogeneity, findings will be presented in a narrative form.Ethics and disseminationThis review is exempt from ethics approval as it will synthesise findings from published studies that have already obtained ethics approval. Our findings will be disseminated through a peer-reviewed journal article, and national and international conference and seminar presentations.Trial registration detailsThis study is registered with PROSPERO (CRD42020209422).
171 Early senior assessment and access to CT in an emergency department
Authors: Crespo Marta de Andres , Zogg Cheryl , Novak Alex , Metcalfe David 
Published: January 2021

Aims/Objectives/BackgroundThe Rapid Assessment and Treatment (RAT) model provides early senior assessment of undifferentiated ‘majors’ patients and has been proposed as a strategy for improving Emergency Department (ED) efficiency. One goal of RAT is to organise essential imaging at an earlier stage within the patient’s ED journey. This study aimed to identify any potential early impact of a RAT initiative on time to imaging for patients requiring CT head.Methods/DesignElectronic health record data were extracted for all patients that underwent head CT while in the ED over a 54-month period (48 months pre-intervention and 6 post-intervention) at a single Major Trauma Centre in England. Interrupted time series analysis was used to estimate any effect of RAT on time from ED arrival to imaging.Results/ConclusionsThere was a pre-existing gradual trend over the entire time series towards patients waiting less time for CT. Although time to CT appeared to increase when the RAT model was implemented, this change was small and not statistically significant (9.8 [95% CI -1.6 to 21.3] minutes). Following RAT implementation, the pre-existing trend towards quicker access to CT resumed but without any change in the slope of the line.This early evaluation did not identify an association between RAT implementation and speed of access to CT head. The system may mature over time and further evaluations will be necessary to identify delayed effects on access to imaging as well as other process measures intended to improve ED safety and efficiency.
130 Quality improvement project – improving the quality of care for homeless patients presenting to the homerton university hospital emergency department 2019-20
Authors: Leung Phoebe , Chambers Jane , Morris Amber , Arthur Kobbina , Prowse Fenella , Crowson Richard , Niven William 
Published: January 2021

Aims/Objectives/BackgroundHomelessness is on the rise in the UK. The problem identified specific to homeless patient care was clinician understanding of the homeless person’s social needs to form an adequate discharge plan as well as completing their legal duty to refer such patients to the local housing authority.Methods/DesignThis quality improvement project (QIP) aimed to reduce the reattendance rate of homeless patients presenting to the Homerton University Hospital (HUH) Emergency Department (ED) by 20% from November 2019 to April 2020. This would be done by improving social history taking, signposting of patients to appropriate resources, and performing the legal duty to refer. Using the PDSA cycle method, interventions included a week of presentations to inform clinicians of the process measures; an advertising campaign; and a defined flowchart process for the duty to refer.Results/ConclusionsThe QIP yielded the following results in terms of median baselines: social history taking 60% to 88%, signposting to resources 30% to 67%, and duty to refer 0 to 41%. There was no change to the outcome measure of reattendance rate, maintained at 40% throughout the project and hence the QIP did not meet its SMART aim.However this may have been the result of the decision to cut short data collection time due to the unprecedented COVID-19 pandemic which saw overall reduction in ED patient attendance. Most street homeless persons were put up in temporary hotels in the government funded scheme ‘Everybody In’, lockdown meant the hidden homeless should stay indoors, and a ban on court evictions has been extended until 23 August 2020.Nonetheless, work to improve quality of care continued with a new pathway for safe discharge of homeless patients with suspected COVID-19. Planning ahead for post pandemic times has brought about a new standard operating procedure, which will ensure sustainability of the QIP.
419 What are the priorities for older adults attending the ED? Findings from a multiple stakeholder group consensus meeting
Authors: Graham Blair , Endacott Ruth , Smith Jason E , Barham Ffion , Latour Jos M 
Published: January 2021

Aims/Objectives/BackgroundPatient Reported Experience & Outcome Measures (PREMs/PROMs) are not yet well established in emergency care. This study aimed to determine priorities for older adults attending the ED, to inform item inclusion for a new PREM/PROM.Methods/DesignOne hundred thirty-five priority statements, linked to suggested PREM/PROM items, were derived from the literature, patient interviews (n=24) and staff focus groups (n=7)(October 2018- April 2019). All statements had a Flesch-Kincaid Reading Ease score >70. A one-day consensus meeting was held, December 2019.Invitations were issued via social media, patient/public involvement groups and charities. Following focus groups to assess interpretability, nominal group technique was used to prioritise statements. Individuals scored statements from 1(least important) to 9(most important). Statements with a median score of >6.5 were ‘critically important’, 3.5 to 6 ‘important, not critical’, and <3 ‘less important’. Inter-rater agreement was assessed using mean absolute deviation from the median (MADM). ‘Critically important’ or ‘less important’ statements with MADM <50% were automatically included or excluded, respectively. Statements deemed ‘important, not critical’, or with MADM >50% underwent further voting.Remaining statements underwent dichotomous voting. A >70% favourable majority was required for inclusion.Results/ConclusionsTwenty-nine participants attended. Average age was 65.6 years (R32—78). Experiences of emergency care were as a patient (n=16(55.2%)), accompanying person (n=11(37.9%)), third-sector representative (n=14(48.2%)) and/or clinician (n=7(27.6%)).Initial prioritisation yielded 71 statements for inclusion. Further voting led to the inclusion of another 31 statements (102 total).Statements relating to care delivery, communication and emotional needs ranked as more important overall. Statements related to waiting were considered less important (seesupplementary file).Participants reported having ‘adequate say’ during the meeting (76.9% Strongly Agree).ConclusionThis meeting established priorities for older adults attending the ED. The low priority assigned to waiting confounds some previous findings. Further item reduction is planned to create a final PREM/PROM for older adults.
216 Evaluation of the use of tele-sim in the examination setting for final year emergency medicine residents in India
Authors: Gidwani Shweta , Ahluwalia Tania , Douglass Katherine 
Published: January 2021

Aims/Objectives/BackgroundTravel restrictions during this Covid-19 pandemic created a barrier to bringing external examiners to conduct simulation assessments, a crucial component of emergency medicine examinations in India. Indefinite postponement would prevent several final year trainees from progressing and would have added to their stress and frustration during an already challenging time.We conducted these evaluation via tele-simulation and sought to evaluate the feasibility and effectiveness of tele-simulation as tool for assessing the management of critically ill or injured patients by emergency medicine (EM) trainees. Our secondary outcome was a survey evaluating the attitudes and perceptions of fairness of this remote simulation modality for both faculty and trainees.Methods/Design104 residents from 14 separate hospitals across India were evaluated in pairs by a local facilitator and a remote examiner via Zoom. There were 14 local facilitators and 10 remote examiners based in the US, UK and India. All residents examined were given the same simulation case he examination over the course of 7 hours. Real time online structured evaluation forms were completed by both evaluators and each candidate was discussed after every pair to agree a pass/fail grade. The external examiners were blinded to the students overall 3 year performance, theory and thesis results. The tele-simulation evaluation was triangulated with the final examination theory and thesis exam grades and overall clinical performance and feedback over 3 yrs from their local supervisor. We surveyed local faculty, remote examiners and trainees.Results/Conclusions52 paired tele-simulation examinations were conducted by 24 local and remote examiners from India, United Kingdom and USA over 7 hours. Of the 14 candidates who failed, their tele-simulation grades correlated with overall performance. The interim data analysis of the survey results show that 96.7% thought the exam was fair Tele-simulation is a feasible and effective way to evaluate EM trainees.
356 Comparison of qSOFA, and hospital early warning scores for prognosis in suspected sepsis in emergency department patients: a systematic review
Authors: Sabir Lisa , Ramlakhan Shammi , Goodacre Steve 
Published: January 2021

Aims/Objectives/BackgroundSepsis is a major cause of morbidity and mortality and many tools exist to facilitate early recognition. The current international consensus definition of sepsis recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score in the emergency department (ED) to rapidly identify those who are likely to have poor outcomes. Early Warning Scores (EWS) are used more routinely; if these could provide the same information, they could allow standardisation and streamlining of effort.This review compares two toolsqSOFA and EWS (National/Modified Early Warning Scores (NEWS/MEWS)) for predicting intensive care (ICU) admission and mortality when applied to suspected sepsis patients in the ED.Methods/DesignA literature search was conducted using Medline, CINAHL, Embase, and Cochrane Library, hand searching of references and a grey literature search with no language or date restrictions. Two authors selected studies and quality assessment completed using QUADAS-2. Area under the Receiver Operating Characteristic Curve (AUROC), sensitivities, and specificities were compared.Results/ConclusionsResults12 studies were included, totalling 395,661 patients. All reported mortality and six reported ICU admission.AUROC estimates were variable ranging from little better than chance to good prediction. The ranges demonstrated overlap between scores suggesting little difference for predicting mortality (NEWS: 0.59–0.88; qSOFA: 0.57–0.79; MEWS 0.56–0.75). However, individual papers mostly reported higher AUROC values for NEWS than qSOFA. NEWS demonstrated a trend to better sensitivity for ICU admission (NEWS≥5 0.46–0.91; qSOFA≥2 0.12–0.53) and mortality (NEWS≥5 0.51–0.97; qSOFA≥2 0.14–0.7) but lower specificity (ICU: NEWS≥5 0.25–0.91; qSOFA≥2 0.67–0.99. Mortality: NEWS≥5 0.22–0.91; qSOFA≥2 0.58–0.99).ConclusionThe wide range of AUROC estimates and high heterogeneity limit our conclusions. Allowing for this, the NEWS AUROC was consistently higher than qSOFA within individual papers. Both scores allow threshold setting, determined by the preferred compromise between sensitivity and specificity. At established thresholds NEWS trended to higher sensitivity whilst qSOFA favoured specificity.