bluuebunny/crossref_metadata_2025_split huggingface dataset:
Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research
Authors: Ip Athena , Muller Ingrid , Geraghty Adam W A , Platt Duncan , Little Paul , Santer Miriam 
Published: February 2021

ObjectivesThe objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs).DesignSystematic review and synthesis of qualitative papers.MethodsPapers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings.ResultsA total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people’s experience of acne and HCPs’ attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was ‘trivialised’ by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others.ConclusionsPeople need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use.PROSPERO registration numberCRD42016050525.
Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial
Authors: Kiely Bridget , Clyne Barbara , Boland Fiona , O"Donnell Patrick , Connolly Deirdre , O"Shea Eamon , Smith Susan M 
Published: February 2021

IntroductionLink workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity.Methods and analysisThe protocol presents the proposed pragmatic RCT, involving 10 general practitioner (GP) practices and 600 patients. Eligible participants will be community dwelling adults with multimorbidity (≥two chronic conditions) identified as being suitable for referral to a practice-based link worker. Following baseline data collection, the patients will be randomised into intervention group that will meet the link worker over a1-month period, or a ‘wait list’ control that will receive usual GP care. Primary outcomes are health-related quality of life as assessed by EQ-5D-5L and mental health assessed by Hospital Anxiety and Depression Scale. Secondary outcomes are based on the core outcome set for multimorbidity. Data will be collected at baseline and on intervention completion at 1 month using questionnaires self-completed by participants and GP records. Parallel process and economic analyses will be conducted to explore participants’ experiences and examine cost-effectiveness of the link worker intervention.Ethics and disseminationEthical approval has been granted by the Irish College of General Practitioners Ethics Committee. The findings will be published in peer-reviewed journals.Trial registration numberISRCTN10287737;Pre-results.
Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia
Authors: Gordon Louisa G , Elliott Thomas M , Forde Brian , Mitchell Brett , Russo Philip L , Paterson David L , Harris Patrick N A 
Published: February 2021

ObjectiveTo predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care.DesignBudget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends.SettingQueensland, Australia.ParticipantsHospitalised patients.InterventionsWGS surveillance of six common multidrug-resistant organisms (Staphylococcus aureus, Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterobacter sp and Acinetobacter baumannii) compared with standard of care or routine microbiology testing.Primary and secondary outcomesExpected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections.ResultsIn 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits.ConclusionsCompared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.
Methodology for task-shifting evidence-based psychological treatments to non-licenced/lay health workers: protocol for a systematic review
Authors: Kanzler Kathryn E , Kilpela Lisa Smith , Pugh Jaqueline , Garcini Luz M , Gaspard Christine S , Aikens James , Reynero Erick , Tsevat Joel , Lopez Eliot Santana , Johnson-Esparza Yajaira , Ramirez Amelie G , Finley Erin P 
Published: February 2021

Introduction‘Task-shifting’ or ‘task-sharing’ is an effective strategy for delivering behavioural healthcare in lower resource communities. However, little is known regarding the actual steps (methods) in carrying out a task-shifting project. This paper presents a protocol for a systematic review that will identify steps in adapting an evidence-based psychological treatment for delivery by lay/non-licenced personnel.Methods and analysisA systematic review of peer-reviewed, published studies involving a non-licenced, non-specialist (eg, community health worker, promotor/a, peer and lay person) delivering an evidence-based psychological treatment for adults will be conducted. Study design of selected articles must include a statistical comparison (eg, randomised controlled trials, quasiexperimental trials, pre–post designs and pragmatic trials). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including PubMed, the Cochrane Library, Cochrane Central Register of Controlled Trials, SCOPUS, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo and Google Scholar will be searched from 2000 to 2020. Risk of bias will be assessed using the Cochrane Collaboration’s Risk of Bias (RoB 2) tool, and publication bias will be evaluated with the Cochrane GRADE approach. A narrative synthesis will be conducted for all included studies, and a summary table following Proctor’s framework for operationalising implementation strategies will be included. This protocol was developed following the 2015 guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.Ethics and disseminationThis review will analyse data from published studies only; thus, it will not require institutional board review. Findings will be presented at conferences, to the broader community via the Community Health Worker Translational Advisory Board and social media, and the final systematic review will be published in a peer-reviewed journal.
Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review
Authors: Stockwell Stephanie , Trott Mike , Tully Mark , Shin Jae , Barnett Yvonne , Butler Laurie , McDermott Daragh , Schuch Felipe , Smith Lee 
Published: February 2021

ObjectiveIn March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called ‘lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.Design, data sources and eligibility criteriaElectronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.ResultsSixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.ConclusionGiven the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.
Gulf War Syndrome: a review of current knowledge and understanding
Authors: Minshall D 
Published: February 2021

AbstractThe 1991 Persian Gulf War was a resounding military success for coalition forces, who liberated Kuwait following the Iraqi invasion. The medical legacy we have from the conflict is the poorly understood, yet remarkable, phenomenon of Gulf War Syndrome, which surfaced soon after.Epidemiological research has proven beyond doubt that Gulf War veterans report a wide variety of symptoms, in excess of appropriately matched control subjects, and experience worse general health. Numerous toxic environmental hazards have been suggested as causes of Gulf War Syndrome, yet exhaustive scientific study has failed to provide conclusive proof of any link. No novel or recognised disease has been found to account for the symptomatic burden of veterans, and the optimal treatment remains uncertain.This understanding can be added to from an anthropological perspective, where the narratives of those afflicted provide further insight. The nature of military life was changing at the time of the Gulf War, challenging the identity and beliefs of some veterans and causing socio-cultural distress. The symptomatic presentation of Gulf War Syndrome can be considered an articulation of this disharmony. Gulf War Syndrome can also be considered within the group of post-combat disorders such as shellshock, the like of which have occurred after major wars in the last century. With the current withdrawal from Afghanistan, the Defence Medical Services (DMS) should heed the lessons of history.
Acute tonsillitis and its complications: an overview
Authors: Bartlett A , Bola S , Williams R 
Published: February 2021

AbstractAcute tonsillitis may be defined as inflammation of the tonsils, predominantly due to infection. It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to generalised infection of the pharynx and commonly affects young healthy adults. Simple sore throats secondary to viral or bacterial pharyngitis are very common and generally do not require hospital admission or antimicrobial treatment. Supportive management in the form of analgesia and adequate hydration is often sufficient. However, there is potential for life-threatening complications to develop, highlighting the need for basic knowledge in the management of these conditions.This article aims to provide an overview of acute tonsillitis and its complications, including peritonsillar and parapharyngeal abscess formation. Specific attention will be given to the pathogenesis, diagnosis, investigation and management of each condition, in particular advising on emergency pre-shore treatment and indications for referral to an Ear, Nose and Throat Department. We will also summarise important guidelines and evidence from the literature to support these management decisions.
‘The Drug of War’ – a historical review of the use of Ketamine in military conflicts
Authors: Mercer S J 
Published: February 2021

AbstractAnaesthesia for surgery during armed conflict was traditionally based on simple and reliable techniques. These often required a minimum of equipment and drugs while ensuring rapid and safe patient recovery. Ketamine, which first became available in Britain in the 1970s, was thought to offer certain favorable characteristics for use as a military anaesthetic agent. This article discusses the use of ketamine in many of the major armed conflicts that have occurred since its introduction. It also catalogues the methods used by anaesthetists at the time and their opinions of the drug’s success.
Case Study - Leprosy
Authors: Wood A M , Wood C M , Bakker-Dyos J 
Published: February 2021

AbstractWe present the case of a 26 year old Indian base worker who attended the Role 2 enhanced hospital in Iraq with a case of leprosy. The patient presented four times over a 12 month period with non-specific pain in the right hand and forearm combined with a large lesion of dry skin and reduced sensation in the forearm. A clinical diagnosis of leprosy was made, which was subsequently confirmed as paucibacillary leprosy by skin smears sent to the UK. It was not possible to treat the patient locally and a recommendation made to the patient’s employer that the patient return to India to commence treatment.
Significant Neurological Presentations in Commando Trained Personnel: Case Studies and Consideration of Differential Diagnosis
Authors: Williams RJ , Howes RJ , Chabda S , Chalder A 
Published: February 2021

AbstractA 27-year-old Royal Marine presented to his sickbay following two episodes of sudden onset visual disturbance. A subsequent MRI Scan demonstrated ischaemic changes in the territory of his right posterior cerebral artery. Transthoracic echocardiography was normal but a bubble contrast study was strongly positive indicating the presence of a relatively large patent foramen ovale (PFO). He underwent endovascular closure of his patent foramen ovale and was subsequently upgraded back to full duties.A 35-year-old Army Sergeant presented with sudden onset collapse, right sided weakness, dysarthria and confusion. He was airlifted to a Host Nation hospital and following a normal CT head underwent thrombolysis in the Emergency Department. This was unsuccessful but a CT guided embolectomy led to complete resolution of symptoms. Subsequent transthoracic echo revealed a PFO. He underwent endovascular closure and has since been returned to full duties.The incidence of PFO is common affecting 27% of the population but the incidence of ischaemic stroke in young adults (aged 15-45 years old) is rare. This maybe linked to the size of the PFOs in symptomatic individuals.1These case reports emphasise the requirement for further investigation of individuals presenting with collapse and persisting neurology. Differential diagnosis and initial management for primary care and pre-hospital clinicians is also reviewed.
The Birmingham Military Trauma Registrar. A Personal View
Authors: Hollingsworthx A C 
Published: February 2021

AbstractThe military registrar is responsible for the co-ordination of care of returning battlefield casualties at Role 4 Royal Centre for Defence Medicine (RCDM). Traditionally two military specialty registrars (StR) providing a 24-hour a day service 365 days a year have shared this responsibility.For Military StR3 General Surgical trainees this is now a recognized training post providing military trainees the opportunity of gaining exposure to battlefield casualties at an early stage in their specialty training.This is a personal account of my time as the military registrar and the training opportunities to be gained for this model of military medical training.Whilst the post is busy and the on call rota demanding the opportunities for surgical trainees are excellent and the requirements of the Intercollegiate Surgical Curriculum Programme (ISCP) can be met ensuring seamless progression to StR 4 training. This is a highly desirable post for junior military registrars.
The management of acute appendicitis
Authors: Brogden T G , Streets C G 
Published: February 2021

AbstractAppendicitis is the most common general surgical condition and peaks in incidence at the age of those serving in the military. Diagnosis can be extremely difficult with very vague signs and symptoms. This review aims to highlight management considerations that should be taken into account when faced with appendicitis in a military setting, including in the pre-hospital and pre-shore environment. Current controversies surrounding appendicitis management, and the effect these might have on the management of the military patient, are debated.
An audit of the cost effectiveness of protocol-driven versus surgeon-directed pre-operative assessment of NHS patients referred to a General Surgeon
Authors: Woolley S D , Walsh L , Lambert A W 
Published: February 2021

AbstractAimsPre-operative assessment (POA) is now commonplace and follows established protocols. This audit compares the costeffectiveness
of surgeon-directed (SD) POA compared to the standard practice of protocol-driven (PD) POA.MethodsOne hundred and fifty-six NHS patients who were referred to a single surgeon during 2009 were allocated to one of three groups. Group 1: SDPOA required no investigations, whereas the PDPOA would have mandated only Methycillin-Resistant Staphylococcus aureus (MRSA) screening and urinalysis; Group 2: SDPOA required no pre-operative investigations, whereas the PDPOA would have required investigations to be performed; Group 3: SDPOA recommended selective investigations, PDPOA required additional tests. For each group the investigations requested and performed, their cost and whether the results affected patient care were recorded. There is no individual PDPOA group, but the cost of the extra tests was calculated where the PDPOA protocols were followed and therefore the cost differed between the SDPOA and PDPOA.ResultsThe total cost for all investigations for the 156 patients was £43,985. A potential cost saving of £9,694 (group 2) and £8,898 (group 3) was demonstrated. The total potential saving identified for all 3 groups was £18,592, which was 42% of the total cost of all the investigations. Patient care was not affected by these additional investigations.ConclusionsThere were no observed peri-operative complications during the study, implying that the additional pre-operative investigations were clinically unnecessary and identifying an additional cost saving of £18,592.
New Joiners Routine (NJR) – A novel screening tool in military primary care
Authors: McMenamin D , Rainey O , Evans G 
Published: February 2021

AbstractIntroduction– This paper describes and audits a novel method of health care screening in a military setting and questions the validity of the current PULHHEEMS system. The system involves screening patients at entry into an establishment with the aim of making them fit for task.Methods– A retrospective DMICP case note review was conducted over 3 months following the introduction of the New Joiners Routine (NJR), to assess the level of positive screening findings, and the number of medical interventions that resulted from this screening. Key Performance Indicators (KPIs) were also assessed during the time frame of the audit.Results – 131/194 (67.5%) had an unmet health need/ positive screening finding. This led to 66 medical interventions in 54 (25.7%) patients. KPIs during this period were markedly improved.Discussion – Although not conclusive, this audit strongly suggests an improvement in culture in making personnel fit for task, and reflects the medical evidence of moving away from asymptomatic periodic health screening to targeted health screening.
Injuries and medical issues on the Zambezi “Great River”
Authors: Hammond T , Hammond AM 
Published: February 2021

AbstractWe report the injuries and medical issues incurred during a rowing expedition conducted along the Zambezi River in May 2011. All injuries and illnesses requiring medical intervention were recorded during a 30-day expedition. There were 22 rowers and 8 support staff sustaining 32 injuries, an injury incidence of 36 per 1000 days. We discuss the medical issues regarding conducting an expedition along the Zambezi and the medical preparation and education required to successfully support wilderness expeditions.
A generalization of the Einstein–Maxwell equations
Authors: Cotton Fredrick W. 
Published: February 2021

AbstractThe proposed modifications of the Einstein–Maxwell equations include: (1) the addition of a scalar term to the electromagnetic side of the equation rather than to the gravitational side, (2) the introduction of a four-dimensional, nonlinear electromagnetic constitutive tensor, (3) the addition of curvature terms arising from the non-metric components of a general symmetric connection and (4) the addition of a non-isotropic pressure tensor. The scalar term is defined by the condition that a spherically symmetric particle be force-free and mathematically well behaved everywhere. The constitutive tensor introduces two structure fields: One contributes to the mass and the other contributes to the angular momentum. The additional curvature terms couple both to particle solutions and to localized electromagnetic and gravitational wave solutions. The pressure term is needed for the most general spherically symmetric, static metric. It results in a distinction between the Schwarzschild mass and the inertial mass.