bluuebunny/crossref_metadata_2025_split huggingface dataset:
Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review
Authors: Kastner Monika , Hayden Leigh , Wong Geoff , Lai Yonda , Makarski Julie , Treister Victoria , Chan Joyce , Lee Julianne H , Ivers Noah M , Holroyd-Leduc Jayna , Straus Sharon E 
Published: April 2019

ObjectivesTo understandhowandwhyeffective multi-chronic disease management interventions influence health outcomes in older adults 65 years of age or older.DesignA realist review.Data sourcesElectronic databases including Medline and Embase (inception to December 2017); and the grey literature.Eligibility criteria for selecting studiesWe considered any studies (ie, experimental quasi-experimental, observational, qualitative and mixed-methods studies) as long as they provided data to explain our programme theories and effectiveness review (published elsewhere) findings. The population of interest was older adults (age ≥65 years) with two or more chronic conditions.AnalysisWe used the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and publication criteria for our synthesis aimed at refining our programme theories such that they contained multiple context-mechanism-outcome configurations describing the ways different mechanisms fire to generate outcomes. We created a 3-step synthesis process grounded in meta-ethnography to separate units of data from articles, and to derive explanatory statements across them.Results106 articles contributed to the analysis. We refined our programme theories to explain multimorbidity management in older adults: (1) care coordination interventions with the best potential for impact are team-based strategies,disease managementprogrammes andcase management; (2) optimised disease prioritisation involves ensuring that clinician work with patients to identify what symptoms are problematic and why, and to explore options that are acceptable to both clinicians and patients and (3) optimised patient self-management is dependent on patients’ capacity for selfcare and to what extent, and establishing what patients need to enable selfcare.ConclusionsTo optimise care, both clinical management and patient self-management need to be considered from multiple perspectives (patient, provider and system). To mitigate the complexities of multimorbidity management, patients focus on reducing symptoms and preserving quality of life while providers focus on the condition that most threaten morbidity and mortality.PROSPERO registration numberCRD42014014489.
How universal are universal preschool health checks? An observational study using routine data from New Zealand’s B4 School Check
Authors: Gibb Sheree , Milne Barry , Shackleton Nichola , Taylor Barry J , Audas Richard 
Published: April 2019

ObjectivesWe aimed to estimate how many children were attending a universal preschool health screen and to identify characteristics associated with non-participation.DesignAnalysis of population-level linked administrative data.ParticipantsChildren were considered eligible for a B4 School Check for a given year if:(1) they were ever resident in New Zealand (NZ),(2) lived in NZ for at least 6 months during the reference year, (3) were alive at the end of the reference year, (4) either appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing or general practitioner enrolment datasets during the reference year or (5) had a registered birth in NZ. We analysed 252 273 records over 4 years, from 1 July 2011 to 30 June 2015.ResultsWe found that participation rates varied for each component of the B4 School Check (in 2014/2015 91.8% for vision and hearing tests (VHTs), 87.2% for nurse checks (including height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status) and 62.1% for SDQ – Teacher [SDQ-T]), but participation rates for all components increased over time. Māori and Pacific children were less likely to complete the checks than non-Māori and non-Pacific children (for VHTs: Māori: OR=0.60[95% CI 0.61 to 0.58], Pacific: OR=0.58[95% CI 0.60 to 0.56], for nurse checks: Māori: OR=0.63[95% CI 0.64 to 0.61], Pacific: OR=0.67[95% CI 0.69 to0.65] and for SDQ-T: Māori: OR=0.76[95% CI 0.78 to 0.75], Pacific: OR=0.37[95% CI 0.38 to 0.36]). Children from socioeconomically deprived areas, with younger mothers, from rented homes, residing in larger households, with worse health status and with higher rates of residential mobility were less likely to participate in the B4 School Check than other children.ConclusionThe patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they potentially require. There needs to be an increased effort by public health organisations, community and whānau/family to ensure that all children are tested and screened.
Nutraceuticals and nutritional supplements for the treatment of bipolar disorder: protocol for a systematic review
Authors: Ashton Melanie M , Berk Michael , Ng Chee H , Hopwood Malcolm , Kavanagh Bianca , Williams Lana J , Sarris Jerome , Dean Olivia M 
Published: April 2019

IntroductionFirst line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms?Methods and analysisClinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.Ethics and disseminationThis review will only look at published data (already reviewed for ethical compliance); therefore, ethical approval is not required. We aim to publish the systematic review in a peer-reviewed journal and present at conferences.PROSPERO registration numberCRD42019100745.
University students’ understanding and perceptions of schizophrenia in the UK: a qualitative study
Authors: Cadge Charlotte , Connor Charlotte , Greenfield Sheila 
Published: April 2019

ObjectiveTo explore lay understanding and perceptions of schizophrenia in university students.DesignQualitative study using semi-structured interviews and thematic analysis.SettingThe University of Birmingham, West Midlands.Participants20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1).ResultsFindings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause.ConclusionsThe university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.
Burden, risk factors and outcomes of hyperemesis gravidarum in low-income and middle-income countries (LMICs): systematic review and meta-analysis protocol
Authors: Dinberu Mesfin Tadese , Mohammed Mohammed Akibu , Tekelab Tesfalidet , Yimer Nigus Bililign , Desta Melaku , Habtewold Tesfa Dejenie 
Published: April 2019

IntroductionHyperemesis gravidarum (HG) is a pregnancy condition characterised by excessive nausea and vomiting resulting in dehydration, weight loss and serious adverse pregnancy outcomes including termination of pregnancies. Even though evidence in low-income and middle-income countries (LMICs) is limited, the prevalence of HG in pregnancy ranges from 0.3% to 10.8%. With this systematic review and meta-analysis, we aim to determine the prevalence/burden, risk factors, and maternal and perinatal outcomes of HG in LMICs.MethodsPubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS databases will be searched. Reference lists of selected articles will be assessed in order to identify other potential studies of interest. Observational studies and (non) randomised controlled trials conducted from January 2000 to September 2018 in LMIC will be included. A weighted inverse-variance meta-analysis using fixed-effects and random-effects model will be done to generate a pooled estimate. Funnel plot and Egger’s regression statistical test will be applied to check publication bias. Heterogeneity among studies will be checked using Τ2to determine dispersion. Moreover, meta-regression analysis will be performed to investigate the source of heterogeneity. STATA V.14 will be used to analyse the data.Ethics and disseminationFormal ethical approval and patient consent are not required; as primary data collection will not be employed. The result will be published in a peer-reviewed scientific journal and will be presented at scientific conferences and public press.PROSPERO registration numberCRD42018096284.
Effects of dexmedetomidine on delirium and mortality during sedation in ICU patients: a systematic review and meta-analysis protocol
Authors: Sun Rao , Wang Shuo , Li Shiyong , Yang Chun , Zhao Yilin , Luo Ailin 
Published: April 2019

IntroductionDelirium is very common in patients admitted to intensive care unit (ICU), and may worsen survival in these patients. Several meta-analyses have evaluated the antidelirium effects of dexmedetomidine in ICU patients, but their findings were inconsistent. Recently, several large multicentre randomised clinical trials (RCTs) were published, but they have not yet to be included in any meta-analysis. We will conduct a meta-analysis adding these data to evaluate the effects of dexmedetomidine on delirium and mortality in ICU patients, aiming to terminate controversy and provide robust evidence for guiding clinical practice.Methods and analysisThe Cochrane Central Register of Controlled Trials, PubMed, Embase, ISI Web of Science will be searched from inception to 31 December 2018 for relevant RCTs. Two reviewers will independently screen the identified citations. After quality appraisal and data extraction of included studies, we will conduct meta-analyses for outcomes of interest, including delirium, mortality, length of ICU/hospital stay, time to extubation, ICU costs and adverse effects. The statistical heterogeneity among studies will be assessed by the χ2test and quantified by the I2statistics. We will undertake subgroup analyses to explore heterogeneity and sensitivity analyses to evaluate whether the results are robust. Potential publication bias will be assessed by funnel plot and Egger’s test. At last, the quality of evidence of the main outcomes will be rated using the Grading of Recommendations Assessment, Development and Evaluation system.Ethics and disseminationThe present study is a meta-analysis based on published studies, thus ethical approval is not needed. Our review will elucidate whether dexmedetomidine could decrease the incidence of delirium and improve survival in ICU patients. Our findings may help clinicians to choose optimal sedative agents for ICU patients. The results of this meta-analysis will be submitted to a peer reviewed journal for publication.PROSPERO registration numberCRD42018095358.
Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study
Authors: Hashimoto Hideki , Matsui Hiroki , Sasabuchi Yusuke , Yasunaga Hideo , Kotani Kazuhiko , Nagai Ryozo , Hatakeyama Shuji 
Published: April 2019

ObjectivesTo investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.DesignRetrospective cohort study.SettingDatabase of public health insurance claims in Kumamoto prefecture (Japan).ParticipantsBeneficiaries of the national or late elders’ health insurance system between April 2012 and March 2013.Main outcome measuresOf the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10–19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.ConclusionsBroad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.
Carotid endarterectomy with primary closure versus patch angioplasty in patients with symptomatic and significant stenosis: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials
Authors: Marsman Martijn S , Wetterslev Jørn , Jahrome Abdelkarime Khodadade , Gluud Christian , Moll Frans L , Karimi Amine , Keus Frederik , Koning Giel G 
Published: April 2019

IntroductionUse of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis and trial sequential analysis as well as Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments comparing the benefits and harms of CEA with primary closure of the arterial wall versus CEA with patch angioplasty in patients with a symptomatic and significant carotid stenosis.Methods and analysisThe review shall be conducted according to this published protocol following the recommendations of the ‘Cochrane’ and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Randomised clinical trials comparing CEA with primary closure of the arterial wall versus CEA with patch angioplasty (regardless of used patch materials) in human adults with a symptomatic and significant carotid stenosis will be included. Primary outcomes are all-cause mortality at maximal follow-up, health-related quality of life and serious adverse events. Secondary outcomes are symptomatic or asymptomatic arterial occlusion or restenosis, and non-serious adverse events. We will primarily base our conclusions on meta-analyses of trials with overall low risk of bias. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the precision achieved in all trials as the result of our meta-analyses.Ethics and disseminationThe proposed systematic review will collect and analyse secondary data from published studies therefor ethical approval is not required. The results of the systematic review will be disseminated by publication in a peer-review journal and submitted for presentation at relevant conferences.PROSPERO registration numberCRD42014013416.
Postoperative wound dehiscence after laparotomy: a useful healthcare quality indicator? A cohort study based on Norwegian hospital administrative data
Authors: Helgeland Jon , Tomic Oliver , Hansen Tonya Moen , Kristoffersen Doris Tove , Hassani Sahar , Lindahl Anne Karin 
Published: April 2019

ObjectivesPostoperative wound dehiscence (PWD) is a serious complication to laparotomy, leading to higher mortality, readmissions and cost. The aims of the present study are to investigate whether risk adjusted PWD rates could reliably differentiate between Norwegian hospitals, and whether PWD rates were associated with hospital characteristics such as hospital type and laparotomy volume.DesignObservational study using patient administrative data from all Norwegian hospitals, obtained from the Norwegian Patient Registry, for the period 2011–2015, and linked using the unique person identification number.ParticipantsAll patients undergoing laparotomy, aged at least 15 years, with length of stay at least 2 days and no diagnosis code for immunocompromised state or relating to pregnancy, childbirth and puerperium. The final data set comprised 66 925 patients with 78 086 laparotomy episodes from 47 hospitals.OutcomesThe outcome was wound dehiscence, identified by the presence of a wound reclosure code, risk adjusted for patient characteristics and operation type.ResultsThe final data set comprised 1477 wound dehiscences. Crude PWD rates varied from 0% to 5.1% among hospitals, with an overall rate of 1.89%. Three hospitals with statistically significantly higher PWD than average were identified, after case mix adjustment and correction for multiple comparisons. Hospital volume was not associated with PWD rate, except that hospitals with very few laparotomies had lower PWD rates.ConclusionsAmong Norwegian hospitals, there is considerable variation in PWD rate that cannot be explained by operation type, age or comorbidity. This warrants further investigation into possible causes, such as surgical technique, perioperative procedures or handling of complications. The risk adjusted PWD rate after laparotomy is a candidate quality indicator for Norwegian hospitals.
What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial
Authors: Dismore Lorelle Louise , Echevarria Carlos , van Wersch Anna , Gibson John , Bourke Stephen 
Published: April 2019

ObjectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative study sought to identify facilitators and barriers to implementation of HAH.DesignSemistructured interviews, data were analysed using thematic-construct analysis.SettingInterviews were conducted within patients’ homes and hospitals in North East England.Participants89 participants were interviewees; 44 patients, 15 carers, 15 physicians, 11 specialist nurses and 4 managers.ResultsFacilitators include the following: (1) availability of home comforts and maintaining independence (with positive influences on perceived rate of recovery, sleep quality and convenience for friends, family and carers) and (2) confidence in the continuity of HAH care. Barriers include the following: (1) fear of being alone at home; (2) privacy issues and not wanting visitors and (3) resistance to change. Clinician concerns occasionally delayed return home, principally during the early phase of the trial. Nurses cited higher workload and greater responsibility, but with additional resource and training; overall, they viewed HAH positively. Operational concerns included keeping medical records in a patient’s home and inability to capture activity within current payment systems.ConclusionHAH selected by DECAF was preferred to inpatient care by most patients and their families. Implementation in other hospitals will require education, training and service planning, tailored to overcome the identified barriers.Trial registration numberISRCTN29082260.
Psychometric properties of the Arabic version of the 9-item Shared Decision-Making Questionnaire: the entire process from translation to validation
Authors: Alzubaidi Hamzah , Hussein Amal , Mc Namara Kevin , Scholl Isabelle 
Published: April 2019

ObjectiveTo translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process.DesignMulticentre cross-sectional study.SettingSecondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain).ParticipantsPatients with chronic diseases who attended outpatient clinics of participating hospitals.MeasurementsThe original German SDM-Q-9 was translated to Arabic. International multiphase translation guidelines and the process of cross-cultural adaptation of self-reported measures were used. Various psychometric properties were assessed, including reliability (internal consistency), and construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]).ResultsThe final Arabic version of the SDM-Q-9 was tested among 516 secondary care patients. Internal consistency yielded a Cronbach’s alpha of 0.929 for the whole scale. EFA showed a one-factorial solution, Kaiser-Meyer-Olkin measure of sampling adequacy was 0.907 and Bartlett’s test of sphericity was significant (χ2=3413.69, df=36, p<0.0005). For the CFA, two different models were tested; Model 1 included the nine items and Model 2 was monofactorial that included items 2–9 and thus excluded item 1. Both models were adequate as they produced similar indices.ConclusionsThe Arabic version of SDM-Q-9 showed excellent reliability and acceptable validity parameters among secondary care patients. The newly translated Arabic questionnaire is the first psychometrically tested tool that can be used in the 22 member states of the Arab league to assess patients’ perspectives on the SDM process.