bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of triage systems in emergency care: a systematic review and meta-analysis
Authors: Zachariasse Joany M , van der Hagen Vera , Seiger Nienke , Mackway-Jones Kevin , van Veen Mirjam , Moll Henriette A 
Published: May 2019

ObjectiveTo assess and compare the performance of triage systems for identifying high and low-urgency patients in the emergency department (ED).DesignSystematic review and meta-analysis.Data sourcesEMBASE, Medline OvidSP, Cochrane central, Web of science and CINAHL databases from 1980 to 2016 with the final update in December 2018.Eligibility criteriaStudies that evaluated an emergency medical triage system, assessed validity using any reference standard as proxy for true patient urgency and were written in English. Studies conducted in low(er) income countries, based on case scenarios or involving less than 100 patients were excluded.Review methodsReviewers identified studies, extracted data and assessed the quality of the evidence independently and in duplicate. The Quality Assessment of studies of Diagnostic Accuracy included in Systematic Reviews -2 checklist was used to assess risk of bias. Raw data were extracted to create 2×2 tables and calculate sensitivity and specificity. ED patient volume and casemix severity of illness were investigated as determinants of triage systems’ performance.ResultsSixty-six eligible studies evaluated 33 different triage systems. Comparisons were restricted to the three triage systems that had at least multiple evaluations using the same reference standard (Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System). Overall, validity of each triage system to identify high and low-urgency patients was moderate to good, but performance was highly variable. In a subgroup analysis, no clear association was found between ED patient volume or casemix severity of illness and triage systems’ performance.ConclusionsEstablished triage systems show a reasonable validity for the triage of patients at the ED, but performance varies considerably. Important research questions that remain are what determinants influence triage systems’ performance and how the performance of existing triage systems can be improved.
Prognostic model for traumatic death due to bleeding: cross-sectional international study
Authors: Ageron Francois-Xavier , Gayet-Ageron Angele , Steyerberg Ewout , Bouzat Pierre , Roberts Ian 
Published: May 2019

ObjectiveTo develop and validate a prognostic model and a simple model to predict death due to bleeding in trauma patients.DesignCross-sectional study with multivariable logistic regression using data from two large trauma cohorts.Setting274 hospitals from 40 countries in the Clinical Randomisation of Anti-fibrinolytic in Significant Haemorrhage (CRASH-2) trial and 24 hospitals in the Northern French Alps Trauma registry.Participants13 485 trauma patients in the CRASH-2 trial and 9945 patients in the Northern French Alps Trauma registry who were admitted to hospital within 3 hours of injury.Main outcome measureIn-hospital death due to bleeding within 28 days.ResultsThere were 815 (6%) deaths from bleeding in the CRASH-2 trial and 102 (1%) in the Northern French Alps Trauma registry. The full model included age, systolic blood pressure (SBP), Glasgow Coma Scale (GCS), heart rate, respiratory rate and type of injury (penetrating). The simple model included age, SBP and GCS. In a cross-validation procedure by country, discrimination and calibration were adequate (pooled C-statistic 0.85 (95% CI 0.81 to 0.88) for the full model and 0.84 (95% CI 0.80 to 0.88) for the simple model).ConclusionThis prognostic model can identify trauma patients at risk of death due to bleeding in a wide range of settings and can support prehospital triage and trauma audit, including audit of tranexamic acid use.
Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China
Authors: Bai Jie , Bundorf Kate , Bai Fei , Tang Huiqin , Xue Di 
Published: May 2019

ObjectivesMany strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals’ use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.DesignA retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital’s use of financial incentives to influence CP compliance.SettingEighteen public hospitals in three provinces in China.ParticipantsStratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014.Primary outcome measuresThe proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy).ResultsThe average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance.ConclusionCPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.
Comparison of olanexidine versus povidone-iodine for preventing surgical site infection in gastrointestinal surgery: study protocol for a multicentre, single-blind, randomised controlled clinical trial
Authors: Takeuchi Masashi , Obara Hideaki , Kawakubo Hirofumi , Shinoda Masahiro , Okabayashi Koji , Mayanagi Shuhei , Irino Tomoyuki , Fukuda Kazumasa , Nakamura Rieko , Wada Norihito , Kitago Minoru , Yagi Hiroshi , Abe Yuta , Oshima Go , Hori Shutaro , Tsuruta Masashi , Ishida Takashi , Yokose Takahiro , Hirukawa Kazuya , Isobe Yoh , Sekimoto Yasuhito , Harada Hirohisa , Maeda Yusuke , Shito Masaya , Kondo Takayuki , Sato Yasunori , Kitagawa Yuko 
Published: May 2019

IntroductionThe prevalence of surgical site infection (SSI) remains higher in gastrointestinal surgery than in other surgeries. Although several guidelines have indicated the efficacy of chlorhexidine and povidone-iodine in reducing the SSI rate, the optimal recommendation has still not been established. Therefore, it is necessary to determine the more effective antiseptic for surgical site preparation. Olanexidine (1.5% olanedine, Otsuka Pharmaceutical Factory, Tokushima, Japan), which is a new antiseptic in Japan, has antimicrobial activity against a wide range of bacteria, including Gram-positive and Gram-negative bacteria. Our study will contribute to determining a new antiseptic for use in gastrointestinal and other surgeries.Methods and analysisWe propose a multicentre, randomised controlled clinical trial for comparing two treatments, that is, 1.5% olanexidine or 10% povidone-iodine, for surgical skin preparation to prevent SSI in clean-contaminated gastrointestinal surgeries with surgical wounds. Patients aged ≥20 years at the time of consent will be included. The primary outcome measure is the 30-day postoperative SSI rate. For the primary analysis, which is aimed at comparing the treatment effects, the adjusted risk ratio and its 95% CI will be estimated using the Mantel-Haenszel method.Ethics and disseminationThe protocol was first approved by the Institutional Review Board of Keio University School of Medicine, followed by the institutional review board of each participating site. Participant recruitment began in June 2018. The final results will be published in international peer-reviewed medical journals.Trial registration numberUMIN 000031560; Pre-results.
Engaging primary care physicians in system change – an interpretive qualitative study in a remote and rural health region in Northern British Columbia, Canada
Authors: Snadden David , Reay Trish , Hanlon Neil , MacLeod Martha 
Published: May 2019

ObjectivesTo describe how physicians were engaged in primary healthcare system change in a remote and rural Canadian health authority.DesignA qualitative interpretive study based on a hermeneutic approach.Methods34 transcribed in-depth interviews with physicians and administrators relevant to physician engagement were purposively sampled from a larger data set of 239 interviews gathered over a 3-year period from seven communities engaged in primary healthcare transformation. Interviews were coded and analysed interpretively to develop common themes.SettingThis research is part of a larger study, Partnering for Change I, which investigated the efforts of Northern Health, a rural regional health authority in British Columbia, to transform its healthcare system to one grounded in primary care with a focus on interdisciplinary teams. It reports how physician engagement was accomplished during the first 3 years of the study.ParticipantsInterviews with 34 individuals with direct involvement and experience in the processes of physician engagement. These included 10 physicians, three Regional Executives, 18 Primary Healthcare coordinators and three Division of Family Practice leads.ResultsThree major interconnected themes that depicted the process of engagement were identified: working through tensions constructively, drawing on structures for engagement and facilitating relationships.ConclusionsPhysician engagement was recognised as a priority by Northern Health in its efforts to create system change. This was facilitated by the creation of Divisions of Family Practice that provided a structure for dialogue and facilitated a common voice for physicians. Divisions helped to build trust between various groups through allowing constructive conversations to surface and deal with tensions. Local context mattered. Flexibility in working from local priorities was a critical part of developing relationships that facilitated the design and implementation of system reform.
Projecting stunting and wasting under alternative scenarios in Odisha, India, 2015–2030: a Lives Saved Tool (LiST)-based approach
Authors: Mishra Nihar Ranjan , Mohanty Sanjay K , Mittra Devjit , Shah Mansi , Meitei Wahengbam Bigyananda 
Published: May 2019

ObjectiveAlthough nutrition-specific interventions are designed based on maternal, household and community-level correlates, no attempt has been made to project stunting and wasting and identify intervention priorities in India. The objective of this paper is to model the stunting and wasting in the state of Odisha, India by scaling up maternal and child health interventions under alternative scenarios.DesignThis study primarily used data from National Family Health Survey 4, 2015–2016.MeasuresThe LiST (Lives Saved Tool) software is used to model the nutritional outcomes and prioritise interventions. The projections were carried out under four alternative scenarios: scenario 1—if the coverage indicators continued based on past trends; scenario 2—scaled up to the level of the richest quintile; scenario 3—scaled up to that of Tamil Nadu; and scenario 4—scaled up to an aspirational coverage level.ResultsIn 2015, out of 3.52 million under-5 children in Odisha, around 1.20 million were stunted. By 2030, the numbers of stunted children will be 1.11 million under scenario 1, 1.07 million under scenario 2, 1.09 million under scenario 3 and 0.89 million under scenario 4. The projected stunting level will be 25% under scenario 4 and around 31% under all other scenarios. By 2030, the level of wasting will remain unchanged at 20% under the first three scenarios and 4.3% under scenario 4. Appropriate complementary feeding would avert about half of the total stunting cases under all four scenarios, followed by zinc supplementation. Water connection at home, washing hands with soap and improved sanitation are other effective interventions.ConclusionSustaining the maternal and child health interventions, promoting evidence-based stunting and wasting reduction interventions, and a multisectoral approach can achieve the World Health Assembly targets and Sustainable Development Goals of undernutrition in Odisha.
Violence against older women: a protocol for a systematic review of qualitative literature
Authors: Meyer Sarah R , Lasater Molly E , Garcia-Moreno Claudia 
Published: May 2019

IntroductionThere is sparse evidence globally concerning patterns of and types of violence against women aged 50 and older. Improved understanding of older women’s experiences of violence, including types of violence, perpetrators and health impacts, is needed to address evident gaps in the literature, address requirements for monitoring and reporting on global sustainable development goal indicators, and inform policy and programming for preventing and responding to violence against older women. The aim of the systematic review is to identify, evaluate and synthesise qualitative studies from all countries, exploring violence against women aged 50 and above, identifying types and patterns of violence, perpetrators of violence and impacts of violence on various health outcomes for older women.Methods and analysisA systematic search for qualitative studies of violence against older women will be conducted in the following databases: PubMed, PsycINFO, Embase, CINAHL, PILOTS, ERIC, Social Work Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, ProQuest Criminal Justice and Dissertations and Theses Global. Studies will be focused on violence against older women (aged 50 and above), using qualitative methodology, exploring women’s experiences of any type of violence perpetrated by any type of perpetrator. Two authors will independently review titles and abstracts retrieved through the search strategy. Data extraction will be conducted independently by one author and quality assessment will be conducted by two authors, using an adapted version of the Critical Appraisal Skills Programme scale. Data will be analysed and synthesised using a thematic synthesis approach.Ethics and disseminationEthics approvals are not required as primary data are not being collected. Findings will be disseminated through a publication in a peer-reviewed journal and used to inform development of a module to measure violence against older women, for use in specialised violence against women surveys.PROSPERO registration numberCRD42019119467
Evaluation of the safety and effectiveness of oral propranolol in patients with von Hippel-Lindau disease and retinal hemangioblastomas: phase III clinical trial
Authors: González-Rodríguez Beatriz , Villar Gómez de las Heras Karina , Aguirre Daniel T , Rodríguez-Padial Luis , Albiñana Virginia , Recio-Poveda Lucía , Cuesta Angel M , Botella Luisa Mª , Jiménez-Escribano Rosa María 
Published: May 2019

Backgroundvon Hippel-Lindau disease (VHL) is a multisystem cancer syndrome caused by mutations in theVHLgene. Retinal hemangioblastoma is one of the most common tumours, and when it appears near the optic nerve, its treatment is challenging and risky. To date, no treatment has proven effective in changing the course of the disease. This study was designed to evaluate the safety and effectiveness of propranolol in controlling these tumours.MethodsSeven patients were included. All patients took a daily dose of 120 mg of propranolol for 1 year. Clinical variables were assessed at baseline, and at 1, 3, 6, 9 and 12 months. The primary endpoint of the study was the number and size of retinal hemangioblastomas. On every visit, retinal outcomes and blood biomarkers (such as vascular endothelial growth factor (VEGF) and miR210) were analysed.ResultsNumber and size of retinal hemangioblastomas remained stable in all patients. All of them had initially increased levels of VEGF and miR210. There was a gradual reabsorption of retinal exudation in two patients, correlating with a progressive decrease of both biomarkers. The only adverse effect reported was hypotension in one patient.ConclusionsPropranolol could be used to treat retinal hemangioblastomas in VHL patients, although more studies are needed to determine the ideal dose and long-term effect. VEGF and miR210 should be explored as biomarkers of disease activity. As far as we know, these are the first biomarkers proposed to monitor the VHL disease activity.Trial registration number2014-003671-30
Evaluation of optic canal anatomy and symmetry using CT
Authors: Zhang Xinxin , Lee Yueh , Olson Daniel , Fleischman David 
Published: May 2019

ObjectiveWe aim to describe the anatomy and symmetry patterns of the optic canal in patients having undergone maxillofacial CT imaging.MethodsIn this retrospective chart review, we included all patients who received sinus and maxillofacial CT at the University of North Carolina hospitals between 2008 and 2016, without facial or cranial fractures or other medical conditions that would affect optic canal size. We measured the length of ≥75% enclosed canal, minimum cross-sectional area and minimum diameter bilaterally using iNtuition TeraRecon (Durham, North Carolina) and compared bilateral symmetry using a 20 % difference threshold. Each parameter above was compared among white, black, non-white and non-black patients.ResultsOf 335 patients, the mean canal length was 5.61±2.22 mm. The mean minimum area was 11.84±3.11 mm2. The mean minimum diameter was 3.28±0.55 mm. A total of 39.4% (132/335) of patients had asymmetric canal lengths, 18.8% (63/335) had asymmetric minimum areas, and 12.5% (42/335) had asymmetric minimum diameters. No differences were found between racial groups. The right optic canal was larger than the left (right: 12.12 mm vs left: 11.55 mm, p<0.0001).ConclusionOptic canal asymmetry is not uncommon. It may affect risk of papilloedema severity, explain cases of unilateral or asymmetric papilloedema and possibly asymmetric glaucoma.
Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest
Authors: Ebell Mark H , Vellinga Akke , Masterson Siobhan , Yun Phillip 
Published: May 2019

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.
Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling
Authors: Hedman Kristofer , Moneghetti Kegan J , Christle Jeffrey W , Bagherzadeh Shadi P , Amsallem Myriam , Ashley Euan , Froelicher Victor , Haddad Francois 
Published: May 2019

ObjectivesTo explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.MethodsIn this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if ≥140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.ResultsIn cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p<0.001), body mass index (BMI) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.ConclusionIn a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.
Bedside mental status and outcome in elderly patients admitted for acute coronary syndromes
Authors: Briet Clément , Blanchart Katrien , Lemaître Adrien , Roux Isabelle , Lavergne Kelly , Rocamora Amelia , Bignon Mathieu , Ardouin Pierre , Sabatier Remi , Roule Vincent , Beygui Farzin 
Published: May 2019

ObjectiveWe investigated whether mental status assessed by simple bedside tests in elderly patients admitted for acute coronary syndromes (ACS) was associated with higher risk of mortality.MethodsWe used the data from a prospective, open, ongoing cohort of patients≥75 years old admitted for ACS to a tertiary centre. Cognitive impairment (CogI) was defined by delirium detected by the Confusion Assessment Method or an abnormal Mini Mental State Examination score. A Cox model adjusted on predefined correlates of mortality was used to assess the relationship between CogI and 1-year mortality.ResultsSix-hundred consecutive patients with mental status assessment within 48 hours after admission were included. CogI was identified in 172 (29%) patients among whom 153 (25.5%) had an abnormal Mini Mental State Evaluation and 19 (3.2%) delirium. Death occurred in 49 (28.6%) patients with and 43 (10.5%) patients without CogI at 1 year. There was a significant association between CogI and 1-year mortality (adjusted-HR 2.4, 95% CI 1.53 to 3.62), p<0.001) independent of other covariables. CogI was also independently associated with higher rates of in-hospital bleeding and mortality as well as 3-month rates of all-cause, cardiovascular-related and heart failure-related rehospitalisation.ConclusionsCogI detected by simple bedside tests in patients≥75 admitted for ACS is associated with an increased risk of 1-year mortality and 3 month rehospitalisation independent of other correlates of poor outcome.