bluuebunny/crossref_metadata_2025_split huggingface dataset:
Statistical tools used for analyses of frequent users of emergency department: a scoping review
Authors: Chiu Yohann , Racine-Hemmings François , Dufour Isabelle , Vanasse Alain , Chouinard Maud-Christine , Bisson Mathieu , Hudon Catherine 
Published: May 2019

ObjectiveFrequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user.MethodsWe performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis.ResultsWe identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used.ConclusionsThis scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol
Authors: Jancey Jonine , Leavy Justine Elizabeth , Pollard Christina , Riley Therese , Szybiak Maria , Milligan Megan , Chamberlain Dan , Blackford Krysten 
Published: May 2019

IntroductionLittle progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related to obesity on a global scale. Systems thinking is emerging as a suitable approach for obesity prevention, as it allows health researchers, practitioners and policy-makers to systematically synthesise existing data, expose gaps, inform priority setting and identify leverage points in the system. The aim of this study is to trial a systems thinking approach to better understand the local obesity prevention system, and identify gaps and viable opportunities for health promotion activities to strengthen obesity prevention efforts in an Australian metropolitan health service.Methods and analysisA mixed methods design will be undertaken in a metropolitan health service area in Perth, Western Australia in 2019–2020. A systems inventory audit will be used to identify physical activity, nutrition and overweight/obesity prevention activities taking place in the study area. An organisational network survey will be administered, and a social network analysis undertaken to examine relationships between organisations in the network. The relationships and interactions will compare the level and type of interactions each organisation has within the network. Parameters including density, centrality and betweenness will be computed using UCINET and Netdraw.Ethics and disseminationEthics approval has been obtained from the Curtin University Human Research Ethics Committee (approval number HRE2017-0862). Results will be reviewed with members of the advisory group, submitted to relevant journals and presented at relevant conferences to health promotion practitioners and policy-makers. The area health service, as co-producers of the research, will use findings to inform policy and strategy across the study area.
Protocol of a multimethod descriptive study: adapting hospital-to-home transitional care interventions to the rural healthcare context in Ontario, Canada
Authors: Fox Mary T , Sidani Souraya , Butler Jeffrey I , Skinner Mark W , Alzghoul Manal 
Published: May 2019

IntroductionFaced with costly hospital readmissions of increasingly complex patient populations, transitional care is a priority throughout Ontario, Canada; yet, rural patients have significantly more hospital readmissions and emergency department visits during the first 30 days following hospitalisation than urban patients. Because transitional care (TC) was designed and evaluated with urban patients, addressing urban-rural disparities in TC effectiveness requires increasing the alignment of TC with the needs of patients and families in rural communities and the rural nursing practice context. The study objectives are to (1) determine the perceived acceptability of evidence-based TC interventions targeting postdischarge care management to patients, families and nurses and (2) adapt the interventions to patients’ and families’ needs and the rural nursing practice context.Methods and analysisThis multimethod study has two phases. In phase I, 32–48 patients and families will rate their level of preparedness for discharge and the acceptability of evidence-based TC interventions. Participants will be engaged in semi-structured interviews about their care management needs, their perspectives on the interventions in fitting those needs and in providing suggestions for adapting the interventions to fit their needs. TC interventions perceived as acceptable to patients and families will be examined in phase II. In phase II, 32–48 hospital and home care nurses will rate the acceptability of the interventions identified by patients and families and attend focus group discussions on the feasibility of providing the interventions. Phase I and II data will be analysed using descriptive statistics and qualitative content analysis.Ethics and disseminationEthics approval was obtained from the Research Ethics Board at York University and participating hospital sites. Findings will be communicated through plain language fact sheets, policy briefs, press-releases and peer-reviewed conference presentations and manuscripts.
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study
Authors: Lovink Marleen Hermien , Laurant Miranda GH , van Vught Anneke JAH , Maassen Irma , Schoonhoven Lisette , Persoon Anke , Koopmans Raymond TCM 
Published: May 2019

ObjectivesThis study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.DesignA multiple-case study was conducted that draws on realist evaluation principles.SettingSeven nursing homes in the NetherlandsParticipantsThe primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78).Data collectionData collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.ResultsAn optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.ConclusionsCollaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.
Prognostic factors for acute exacerbation of idiopathic pulmonary fibrosis: protocol for a systematic review and meta-analysis
Authors: Kamiya Hiroyuki , Panlaqui Ogee Mer 
Published: May 2019

IntroductionIdiopathic pulmonary fibrosis (IPF) is a form of chronic fibrosing interstitial pneumonia with unknown disease aetiology. Acute exacerbation (AE) of IPF is an accelerated disease progression beyond its expected course. A 30-day mortality of AE of IPF is 40%. While death may occur, there is much variation in the clinical progression of this condition. Previous attempts have been made to investigate various possible prognostic factors for AE of IPF; however, they have yet to be confirmed. The aim of this systematic review is to clarify these prognostic factors.Methods and analysisIn this review, AE of IPF is the condition of interest, which has been defined according to previously established diagnostic criteria. The primary outcomes of interest include short-term all-cause mortality and pulmonary-cause mortality. The secondary outcomes of interest include long-term mortality and hospital separation for the disease. Primary studies investigating prognostic factors for AE of IPF are eligible for inclusion in this review. All study types are permitted except case reports. Two reviewers will search electronic databases, such as Medline and EMBASE, from 2002 to the 1 April 2019 and extract data independently. Risk of bias in individual studies will be assessed using the Quality in Prognostic Studies tool. Meta-analysis will be conducted for univariate data if at least three studies report the effect of a specific prognostic factor using similar statistical methods. Multivariate results will be reported qualitatively. Subgroup analysis and sensitivity analysis will be considered with the aim of generalising findings to the clinical settings and drawing more robust conclusions. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method will be applied to evaluate the quality of evidence for each prognostic factor.Ethics and disseminationEthical approval will not be required. Results will be reported in a peer-reviewed scientific journal.PROSPERO registration numberCRD42018106172
Longitudinal circulating placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) concentrations during pregnancy in Asian women: a prospective cohort study
Authors: Ng Qiu Ju , Han Jonathan Youxiang , Saffari Seyed Ehsan , Yeo George Seow-Heong , Chern Bernard Su Min , Tan Kok Hian 
Published: May 2019

ObjectivesTo analyse the placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) trends in the normal pregnant Asian population in Singapore.DesignA prospective study was conducted.SettingThe largest tertiary hospital in Singapore.MethodsWomen with single viable pregnancies, less than 14 weeks of gestation, were recruited between September 2010 and November 2013 in KK Women’s and Children’s Hospital. They were followed up from recruitment till their postnatal discharge from the hospital. There were four antenatal visits: gestational age (GA) less than 14+0 weeks of gestation (V1), GA 18+0 to 22+0 weeks (V2), GA 28+0 to 32+0 weeks (V3) and GA 34+0 and above (V4). Serum biochemical markers (sFlt-1, PlGF) were measured at each visit.ResultsThere were 934 participants in the study, of which 674 had normal pregnancy outcomes. The sFlt-1 remained relatively constant till GA 28–32 weeks before it increased (p<0.001). The sFlt-1 levels increased earlier before 30 weeks’ of gestation among the Malay participants and the other ethnicities. For PlGF, the levels increased from the first to the third trimester, peaking at 30–32 weeks before decreasing (p<0.001). Its serum levels significantly differed among the Indian participants and other ethnicities as compared with the Malay and Chinese participants at V3 and V4, (p=0.04 and p<0.001, respectively).ConclusionThere are significant differences in the PlGF and sFlt-1 concentrations during pregnancy between different ethnicities, which should be taken into consideration when using these references values for further research.
Characteristics of self-management among patients with complex health needs: a thematic analysis review
Authors: Gobeil-Lavoie Annie-Pier , Chouinard Maud-Christine , Danish Alya , Hudon Catherine 
Published: May 2019

ObjectiveThere is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.DesignThematic analysis review of the literature.MethodsWe developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000–October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al.ResultsTwenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.ConclusionsThis review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.
Promoting physical activity in regional and remote cancer survivors (PPARCS) using wearables and health coaching: randomised controlled trial protocol
Authors: Hardcastle Sarah J , Hince Dana , Jiménez-Castuera Ruth , Boyle Terry , Cavalheri Vinicius , Makin Greg , Tan Patrick , Salfinger Stuart , Tan Jason , Mohan Ganendra Raj , Levitt Michael , Cohen Paul A , Saunders Christobel , Platell Cameron 
Published: May 2019

IntroductionPhysically active cancer survivors have substantially less cancer recurrence and improved survival compared with those who are inactive. However, the majority of survivors (70%–90%) are not meeting the physical activity (PA) guidelines. There are also significant geographic inequalities in cancer survival with poorer survival rates for the third of Australians who live in non-metropolitan areas compared with those living in major cities. The primary objective of the trial is to increase moderate-to-vigorous PA (MVPA) among cancer survivors living in regional and remote Western Australia. Secondary objectives are to reduce sedentary behaviour and in conjunction with increased PA, improve quality of life (QoL) in non-metropolitan survivors. Tertiary objectives are to assess the effectiveness of the health action process approach (HAPA) model variables, on which the intervention is based, to predict change in MVPA.Methods and analysisEighty-six cancer survivors will be randomised into either the intervention or control group. Intervention group participants will receive a Fitbit and up to six telephone health-coaching sessions. MVPA (using Actigraph), QoL and psychological variables (based on the HAPA model via questionnaire) will be assessed at baseline, 12 weeks (end of intervention) and 24 weeks (end of follow-up). A general linear mixed model will be used to assess the effectiveness of the intervention.Ethics and disseminationEthics approval has been obtained from St John of God Hospital Subiaco (HREC/#1201). We plan to submit a manuscript of the results to a peer-reviewed journal. Results will be presented at conferences, community and consumer forums and hospital research conferences.Trial registration numberACTRN12618001743257; pre-results, U1111-1222-5698
‘I would never have done it if it hadn’t been digital’: a qualitative study on patients’ experiences of a digital management programme for hip and knee osteoarthritis in Sweden
Authors: Cronström Anna , Dahlberg Leif E , Nero Håkan , Ericson Jennifer , Hammarlund Catharina Sjödahl 
Published: May 2019

ObjectivesTo investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support.SettingThis study was conducted at a regional hospital in the southern part of Sweden.MethodsNineteen patients (10 women), median age of 66 (q1–q3, 57–71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation.ResultsThree categories emerged during the interviews:(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care.ConclusionsDigital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one’s own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
Randomised, placebo-controlled, double-blind, double-dummy, multicentre trial comparing electronic cigarettes with nicotine to varenicline and to electronic cigarettes without nicotine: the ECSMOKE trial protocol
Authors: Berlin Ivan , Dautzenberg Bertrand , Lehmann Blandine , Palmyre Jessica , Liégey Emmanuelle , De Rycke Yann , Tubach Florence 
Published: May 2019

IntroductionElectronic cigarettes (EC) mainly with nicotine content are widely used worldwide. Although the number of publications about its use is increasing exponentially, evidence-based, unbiased, conclusive, head-to-head comparisons about its efficacy and safety as an aid for smoking cessation are lacking.Methods and analysisDesign:randomised, placebo and reference treatment-controlled, multicentre, double-blind, double-dummy, parallel-group trial.Participants:smokers smoking at least 10 cigarettes/day in the past year and motivated to quit, aged 18–70 years.Interventions: (A) EC without nicotine (ECwoN) plus placebo tablets of varenicline administered by oral route:placebo condition, (B) EC with nicotine (ECwN) plus placebo tablets of varenicline:ECwN condition.Voltage regulated EC will be used with liquid containing 12 mg/mL of nicotine for ad libitum use.Flavour: blond tobacco. (C)Reference: ECwoN plus 0.5 mg varenicline tablets:varenicline condition.Varenicline administered according to the marketing authorisationauthorisation.Treatment duration: 1 week+3 months.Primary outcome:continuous smoking abstinence rate (CAR) (abstinence from conventional/combustible cigarettes) during the last 4 weeks (weeks 9–12) of the treatment period defined as self-report of no smoking during the previous 2 weeks and expired air carbon monoxide ≤8 at visit 4 at week 10 after target quit date (TQD), that is, 11 weeks after treatment initiation AND at visit 5, week 12 after TQD, that is, 13 weeks after treatment initiation.Secondary outcomes: safety profile; point prevalence abstinence rate; CAR confirmed by urinary anabasine concentration; changes in cigarettes/day consumption; craving for tobacco and withdrawal symptoms with respect of baseline.Ethics and disseminationThe ethics committee approval was obtained on 17 April 2018. All data collected about the study participants will be anonymised. Investigators will communicate trial results to participants, health authorities, healthcare professionals, the public and other relevant groups without any publication restrictions.Trial registration numberNCT03630614; Pre-results.
Creation of a database to assess effects of omega-3, omega-6 and total polyunsaturated fats on health: methodology for a set of systematic reviews
Authors: Hooper Lee , Abdelhamid Asmaa , Brainard Julii , Deane Katherine H O , Song Fujian 
Published: May 2019

ObjectiveTo create a database of long-term randomised controlled trials (RCTs) comparing higher with lower omega-3, omega-6 or total polyunsaturated fatty acid (PUFA), regardless of reported outcomes, and to develop methods to assess effects of increasing omega-6, alpha-linolenic acid (ALA), long-chain omega-3 (LCn3) and total PUFA on health outcomes.DesignSystematic review search, methodology and meta-analyses.Data sourcesMedline, Embase, CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov and trials in relevant systematic reviews.Eligibility criteriaRCTs of ≥24 weeks' duration assessing effects of increasing ALA, LCn3, omega-6 or total PUFAs, regardless of outcomes reported.Data synthesisMethods included random-effects meta-analyses and sensitivity analyses. Funnel plots were examined, and subgrouping assessed effects of intervention type, replacement, baseline diabetes risk and use of diabetic medications, trial duration and dose. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsElectronic searches generated 37 810 hits, de-duplicated to 19 772 titles and abstracts. We assessed 2155 full-text papers, conference abstracts and trials registry entries independently in duplicate. Included studies were grouped into 363 RCTs comparing higher with lower omega-3, omega-6 and/or total PUFA intake of at least 6 months’ duration—the Database.Of these 363 included RCTs, 216 RCTs were included in at least one of our reviews of health outcomes, data extracted and risk of bias assessed in duplicate. Ninety five RCTs were included in the Database but not included in our current reviews. Of these 311 completed trials, 27 altered ALA intake, 221 altered LCn3 intake and 16 trials altered omega-3 intake without specifying whether ALA or LCn3. Forty one trials altered omega-6 and 59 total PUFA.The remaining 52 trials are ongoing though 13 (25%) appear to be outstanding, or constitute missing data.ConclusionsThis extensive database of trials is available to allow assessment of further health outcomes.