bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes
Authors: Lee Eng Sing , Koh Hui Li , Ho Elaine Qiao-Ying , Teo Sok Huang , Wong Fang Yan , Ryan Bridget L , Fortin Martin , Stewart Moira 
Published: May 2021

ObjectivesThere are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes.MethodsWe conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched theJournal of Comorbiditybetween 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment.ResultsNinety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases.ConclusionsWe listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
Developing a systematic approach for Population-based Injury Severity Assessment (PISA): a million-person survey in rural Bangladesh
Authors: Alonge Olakunle , Agrawal Priyanka , Khatlani Khaula , Mashreky Saidur , Hoque Dewan Emdadul Md , Hyder Adnan A 
Published: May 2021

IntroductionThere is currently no defined method for assessing injury severity using population-based data, which limits our understanding of the burden of non-fatal injuries and community-based approaches for primary prevention of injuries. This study describes a systematic approach, Population-based Injury Severity Assessment (PISA) index, for assessing injury severity at the population level.MethodsBased on the WHO International Classification of Functionality conceptual model on health and disability, eight indicators for assessing injury severity were defined. The eight indicators assessed anatomical, physiological, postinjury immobility, hospitalisation, surgical treatment, disability, duration of assisted living and days lost from work or school. Using a large population-based survey conducted in 2013 including 1.16 million individuals from seven subdistricts of rural Bangladesh, information on the eight indicators were derived for all non-fatal injury events, and these were summarised into a single injury severity index using a principal component analysis (PCA). Principal component loadings derived from the PCA were used to predict the severity (low, moderate, high) of non-fatal injuries, and were applied to the fatal injury data to assess the criterion validity of the index. The determinants of non-fatal injury severity were determined using ordered logistic regression.ResultsThere were 119 703 non-fatal injuries and 14% were classified as high severity based on the PISA index. The PISA index accurately predicted 82% of all fatal injuries as highly severe. Non-fatal injuries of high severity were frequent with unintentional poisoning (57%) and violence (35%). Injuries of high severity were commoner among males (OR 1.16, 95% CI 1.12 to 1.21), adults 65 years and older (OR 1.30, 95% CI 1.23 to 1.36), lower socioeconomic status and intentional injuries. Education was associated with reduced odds of high severe injuries.ConclusionThe PISA index provides a valid and systematic approach for assessing injury severity at the population level, and is relevant for improving the characterisation of the burden and epidemiology of injuries in non-health facility-based settings. Additional testing of the PISA index is needed to further establish its validity and reliability.
Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012–2016
Authors: Walsh Mary E , Cronin Sinead , Boland Fiona , Ebell Mark H , Fahey Tom , Wallace Emma 
Published: May 2021

ObjectiveAmbulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation.DesignRepeated cross-sectional study.Setting34 public hospitals in the Ireland.ParticipantsAdults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia).Primary outcome measureAge and sex standardised emergency admission rates (SARs) per 1000 older adults.AnalysisAge and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables.ResultsOver time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7–50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: −2.2 (−3.4 to −0.9, p<0.01)), lower GP supply (adjusted coefficient: −5.5 (−8.2 to −2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs.ConclusionsFuture research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.
Oral health interventions for older people in residential aged care facilities: a protocol for a realist systematic review
Authors: Kenny Amanda , Dickson-Swift Virginia , Chan Carina Ka Yee , Masood Mohd , Gussy Mark , Christian Bradley , Hodge Brad , Furness Susan , Hanson Lisa C , Clune Samantha , Zadow Emma , Knevel Ron J 
Published: May 2021

IntroductionPoor oral health among older people is a global problem impacting on health and well-being. The economic cost to the health system is significant. An ageing population is intensifying the urgency for action. However, poor oral health, particularly for those in residential aged care facilities, continues to be highly resistant to resolution. The overall aims of this realist review are to: (A) explore and synthesise evidence on oral health interventions for older people in residential aged care facilities, (B) produce a causal theory on how contextual factors and mechanisms interact to produce outcomes, and (C) produce guidelines/policies to inform high-quality oral health interventions to improve older people’s oral health in residential aged care facilities.Methods and analysisThe review is guided by the RAMESES publication standards for realist synthesis. Participants include older people in residential aged care facilities, the aged care workforce, carers and families. Interventions include oral healthcare, oral health education, policy interventions and oral health promotion. The five-step realist review process of Pawsonet alwill guide the review: clarification of scope and development of initial framework, systematic searches, study appraisal and data extraction, synthesising evidence, drawing conclusions, and dissemination, implementation and evaluation. Expert input with key stakeholders will occur through a blog. Stakeholders will examine consistencies across studies and an explanatory causal theory will be developed to guide policy and practice.Ethics and disseminationFormal ethical approval was granted by the La Trobe University Ethics Committee HREC 20144. The developed theory will guide education, practice and policy decisions about interventions and the factors that impact on implementation. Using an integrated knowledge translation approach, traditional research outputs such as international conference presentations and publications will be supplemented with stakeholder forums, infographics, blogs, social media postings, webinars, podcasts and writing for web-based independent outlets.PROSPERO registration numberCRD42021155658.
Key dimensions of post-traumatic stress disorder and endothelial dysfunction: a protocol for a mechanism-focused cohort study
Authors: Cleveland Shiloh , Reed Kristina , Thomas Jordan L , Ajijola Olujimi A , Ebrahimi Ramin , Hsiai Tzung , Lazarov Amit , Montoya Amanda K , Neria Yuval , Shimbo Daichi , Wolitzky-Taylor Kate , Sumner Jennifer A 
Published: May 2021

IntroductionBoth trauma exposure and post-traumatic stress disorder (PTSD) are associated with increased risk of cardiovascular disease (CVD), the leading cause of death in the USA. Endothelial dysfunction, a modifiable, early marker of CVD risk, may represent a physiological mechanism underlying this association. This mechanism-focused cohort study aims to investigate the relationship between PTSD (both in terms of diagnosis and underlying symptom dimensions) and endothelial dysfunction in a diverse, community-based sample of adult men and women.Methods and analysisUsing a cohort design, 160 trauma-exposed participants without a history of CVD are designated to the PTSD group (n=80) or trauma-exposed matched control group (n=80) after a baseline diagnostic interview assessment. Participants in the PTSD group have a current (past month) diagnosis of PTSD, whereas those in the control group have a history of trauma but no current or past psychiatric diagnoses. Endothelial dysfunction is assessed via flow-mediated vasodilation of the brachial artery and circulating levels of endothelial cell-derived microparticles. Two higher order symptom dimensions of PTSD—fear and dysphoria—are measured objectively with a fear conditioning paradigm and attention allocation task, respectively. Autonomic imbalance, inflammation, and oxidative stress are additionally assessed and will be examined as potential pathway variables linking PTSD and its dimensions with endothelial dysfunction. Participants are invited to return for a 2-year follow-up visit to reassess PTSD and its dimensions and endothelial dysfunction in order to investigate longitudinal associations.Ethics and disseminationThis study is conducted in compliance with the Helsinki Declaration and University of California, Los Angeles Institutional Review Board. The results of this study will be disseminated via articles in peer-reviewed journals and presentations at academic conferences and to community partners.Trial registration numberNCT03778307; pre-results.
Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study
Authors: D'Souza Sarah , Godecke Erin , Ciccone Natalie , Hersh Deborah , Janssen Heidi , Armstrong Elizabeth 
Published: May 2021

ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.SettingA metropolitan Australian private hospital.ParticipantsFocus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.ResultsThe key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients.ConclusionsBarriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.
Healthy ageing and occupational therapy in South Asian countries: a scoping review protocol
Authors: Mehrotra Shashank , Pundir Prachi , Shetty Ranjitha S 
Published: May 2021

IntroductionThe increasing population of older adults is one of the most significant challenges faced by various countries across the world. South Asian region is accommodating almost a quarter of the world’s population, with nearly 6% of them being >65 years of age. There is a lack of awareness regarding the role of occupational therapists in community settings, the assessments and interventions used by occupational therapists to facilitate healthy ageing among community-dwelling older adults. This scoping review is planned to systematically identify the literature from the last two decades, related to various assessments and interventions provided by occupational therapists to promote healthy ageing among older adults in South Asia.MethodsThis scoping review will be based on the methodological framework given by Arksey and O’Malley and Levacet al.and will include data from January 2000 onwards. The following databases will be included in the search—SCOPUS, MEDLINE (PubMed), Web of Science, CINAHL, EBSCO, Clinical key, Wiley Online, ProQuest and Cochrane library. Screening of titles and abstracts and full texts will be carried out by two reviewers independently in consultation with the third reviewer. Both quantitative and qualitative data will be analysed separately to identify the assessments carried out, interventions provided and factors that influence healthy ageing among community-dwelling older adults aged ≥60 years in South Asia. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used for collating and reporting the results.Ethics and disseminationAs this scoping review uses data from already available literature, it does not require ethics approval. Results will summarise and present the existing literature related to healthy ageing among community-dwelling older adults. We plan to disseminate the results through a peer-reviewed journal, targeting occupational therapists, other rehabilitation workers and researchers from South Asia.
Protocol for assessing if behavioural functioning of infants born <29 weeks’ gestation is improved by omega-3 long-chain polyunsaturated fatty acids: follow-up of a randomised controlled trial
Authors: Gould Jacqueline F , Roberts Rachel M , Anderson Peter J , Makrides Maria , Sullivan Thomas R , Gibson Robert A , McPhee Andrew J , Doyle Lex William , Opie Gillian , Travadi Javeed , Cheong Jeanie L Y , Davis Peter G , Sharp Mary , Simmer Karen , Tan Kenneth , Morris Scott , Lui Kei , Bolisetty Srinivas , Liley Helen , Stack Jacqueline , Best Karen P , Collins Carmel T 
Published: May 2021

IntroductionDuring the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks’ gestation, without the in-utero provisions of DHA. Infants born <29 weeks’ are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants.Methods and analysisInfants born <29 weeks’ gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks’ postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants.Ethics and disseminationThe Women’s and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/16/WCHN/184). Results will be disseminated in peer-reviewed publications and conference presentations.Trial registration numberACTRN12612000503820.
Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol
Authors: Meijering Danielle , Boerboom Alexander L , Gerritsma Carina L E , The Bertram , van den Bekerom Michel P J , van der Pluijm Marco , Vegter Riemer J K , Bulstra Sjoerd K , Eygendaal Denise , Stevens Martin 
Published: May 2021

BackgroundNew surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA.Methods and analysisA multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications.DiscussionThe successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA.Ethics and disseminationThe Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544).Trial registration numberNTR NL8488.
Face-to-face panel meetings versus remote evaluation of fellowship applications: simulation study at the Swiss National Science Foundation
Authors: Bieri Marco , Roser Katharina , Heyard Rachel , Egger Matthias 
Published: May 2021

ObjectivesTo trial a simplified, time and cost-saving method for remote evaluation of fellowship applications and compare this with existing panel review processes by analysing concordance between funding decisions, and the use of a lottery-based decision method for proposals of similar quality.DesignThe study involved 134 junior fellowship proposals for postdoctoral research (‘Postdoc.Mobility’). The official method used two panel reviewers who independently scored the application, followed by triage and discussion of selected applications in a panel. Very competitive/uncompetitive proposals were directly funded/rejected without discussion. The simplified procedure used the scores of the two panel members, with or without the score of an additional, third expert. Both methods could further use a lottery to decide on applications of similar quality close to the funding threshold. The same funding rate was applied, and the agreement between the two methods analysed.SettingSwiss National Science Foundation (SNSF).ParticipantsPostdoc.Mobility panel reviewers and additional expert reviewers.Primary outcome measurePer cent agreement between the simplified and official evaluation method with 95% CIs.ResultsThe simplified procedure based on three reviews agreed in 80.6% (95% CI: 73.9% to 87.3%) of applicants with the official funding outcome. The agreement was 86.6% (95% CI: 80.6% to 91.8%) when using the two reviews of the panel members. The agreement between the two methods was lower for the group of applications discussed in the panel (64.2% and 73.1%, respectively), and higher for directly funded/rejected applications (range: 96.7%–100%). The lottery was used in 8 (6.0%) of 134 applications (official method), 19 (14.2%) applications (simplified, three reviewers) and 23 (17.2%) applications (simplified, two reviewers). With the simplified procedure, evaluation costs could have been halved and 31 hours of meeting time saved for the two 2019 calls.ConclusionAgreement between the two methods was high. The simplified procedure could represent a viable evaluation method for the Postdoc.Mobility early career instrument at the SNSF.