bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey
Authors: Xu Dong Roman , Hu Mengyao , He Wenjun , Liao Jing , Cai Yiyuan , Sylvia Sean , Hanson Kara , Chen Yaolong , Pan Jay , Zhou Zhongliang , Zhang Nan , Tang Chengxiang , Wang Xiaohui , Rozelle Scott , He Hua , Wang Hong , Chan Gary , Melipillán Edmundo Roberto , Zhou Wei , Gong Wenjie 
Published: February 2019

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.Methods and analysis1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.Ethics and disseminationThis study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.
Association between depression and overweight in Chinese adolescents: a cross-sectional study
Authors: Zhao Zhongyi , Ding Ning , Song Shenzhi , Liu Yang , Wen Deliang 
Published: February 2019

ObjectiveBased on a nationally representative adolescent sample, we examined the association of depression on the prevalence of overweight or obesity and whether this association was moderated by gender.MethodsThere were 1081 adolescents from the China Family Panel Studies that participated in our study. Depression in adolescents was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordered logistic regression model was used to quantify its association with overweight or obesity. Analyses were performed for the total group, and separately for males and females.ResultsThe prevalence of depression in Chinese adolescents was 23.22%. Depression (CES-D ≥16) was significantly associated with overweight or obesity (OR=1.47, 95% CI: 1.14 to 1.91, p=0.004) after adjustment for personal, household and regional confounders. Among four subdimensions of depression, depressed affect and lack of positive affect were significantly associated with increases in the odds of overweight or obesity. In females, only lack of positive affect was significantly associated with overweight or obesity, whereas the estimated associations of all other measures of depression on overweight or obesity were positive in males.ConclusionsThese findings provide evidence that depression is associated with overweight or obesity among adolescents in China, especially among males.
Comparison of the contributions of female and male authors to medical research in 2000 and 2015: a cross-sectional study
Authors: Gayet-Ageron Angele , Poncet Antoine , Perneger Thomas 
Published: February 2019

ObjectivesThe proportion of women engaged in clinical research has increased over time. However, it is unclear if women and men contribute to the same extent during the conduct of research and, if so, if they are equally rewarded by a strategic first or last author position. We aim to describe the prevalence of women authors of original articles published 15 years apart and to compare the research contributions and author positions according to gender.DesignRepeated cross-sectional study.SettingPublished original articles.Participants1910 authors of 223 original articles published in theAnnals of Internal Medicinein 2000 and 2015.Primary and secondary outcomes measuresSelf-reported contributions to 10 aspects of the article (primary) and author position on the byline.ResultsThe proportion of women authors increased from 32% (n=243) to 41% (n=469) between 2000 and 2015 (p<0.0001). In 2000, women authors were less frequently involved than men in the conception and design (134 (55%) vs 323 (61%); p=0.0256), critical revision (171 (70%) vs 426 (81%); p=0.0009), final approval (196 (81%) vs 453 (86%); p=0.0381) and obtaining of funding (39 (16%) vs 114 (22%); p=0.0245). Women were more frequently involved than men in administration and logistics (85 (35%) vs 137 (26%); p=0.0188) and data collection (121 (50%) vs 242 (46%); p=0.0532), but they were similarly involved in the analysis and interpretation of data, drafting of the manuscript, provision of materials/patients and statistical expertise. Women were less often last authors than men (22 (9%) vs 82 (16%); p=0.0102). These gender differences persisted in 2015.ConclusionsThe representation of women among authors of medical articles increased notably between 2000 and 2015, but still remained below 50%. Women’s roles differed from those of men with no change over time.
SALMANTICOR study. Rationale and design of a population-based study to identify structural heart disease abnormalities: a spatial and machine learning analysis
Authors: Melero-Alegria Jose Ignacio , Cascon Manuel , Romero Alfonso , Vara Pedro Pablo , Barreiro-Perez Manuel , Vicente-Palacios Victor , Perez-Escanilla Fernando , Hernandez-Hernandez Jesus , Garde Beatriz , Cascon Sara , Martin-Garcia Ana , Diaz-Pelaez Elena , de Dios Jose Maria , Uribarri Aitor , Jimenez-Candil Javier , Cruz-Gonzalez Ignacio , Blazquez Baltasara , Hernandez Jose Manuel , Sanchez-Pablo Clara , Santolino Inmaculada , Ledesma Maria Concepcion , Muriel Paz , Dorado-Diaz P Ignacio , Sanchez Pedro L 
Published: February 2019

IntroductionThis study aims to obtain data on the prevalence and incidence of structural heart disease in a population setting and, to analyse and present those data on the application of spatial and machine learning methods that, although known to geography and statistics, need to become used for healthcare research and for political commitment to obtain resources and support effective public health programme implementation.Methods and analysisWe will perform a cross-sectional survey of randomly selected residents of Salamanca (Spain). 2400 individuals stratified by age and sex and by place of residence (rural and urban) will be studied. The variables to analyse will be obtained from the clinical history, different surveys including social status, Mediterranean diet, functional capacity, ECG, echocardiogram, VASERA and biochemical as well as genetic analysis.Ethics and disseminationThe study has been approved by the ethical committee of the healthcare community. All study participants will sign an informed consent for participation in the study. The results of this study will allow the understanding of the relationship between the different influencing factors and their relative importance weights in the development of structural heart disease. For the first time, a detailed cardiovascular map showing the spatial distribution and a predictive machine learning system of different structural heart diseases and associated risk factors will be created and will be used as a regional policy to establish effective public health programmes to fight heart disease. At least 10 publications in the first-quartile scientific journals are planned.Trial registration numberNCT03429452.
Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren’s syndrome: nationwide population-based cohort study
Authors: Liao Min-Tser , Chien Wu-Chien , Wang Jen-Chun , Chung Chi-Hsiang , Chu Shi-Jye , Tsai Shih-Hung 
Published: February 2019

ObjectiveThe aim of this study was to explore whether patients with Sjögren’s syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan.DesignA nationwide population-based retrospective cohort study.SettingData were extracted from Taiwan’s National Health Insurance Research Database (NHIRD).MethodologyMedical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression.ResultsOverall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test <0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08%vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001).ConclusionPatients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.
Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre
Authors: Brooks John Alexander , McCudden Christopher , Breiner Ari , Bourque Pierre R 
Published: February 2019

ObjectiveWe set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD).MethodsWe reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have ‘pseudo’ ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have ‘true’ ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described.ResultsThe presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. ‘True’ ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with ‘pseudo’ ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001).ConclusionsElevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.
Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study
Authors: Burgon Clare , Darby Janet , Pollock Kristian , van der Wardt Veronika , Peach Tamsin , Beck Lyndsay , Logan Pip , Harwood Rowan H 
Published: February 2019

ObjectiveTo explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.DesignThis is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.SettingCommunity-based falls and memory assessment services in the East Midlands, UK.ParticipantsNurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).ResultsThree substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.ConclusionsHealthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports
Authors: Milani Richard V , Wilt Jonathan K , Entwisle Jonathan , Hand Jonathan , Cazabon Pedro , Bohan Jefferson G 
Published: February 2019

ImportanceAntibiotic resistance is a global health issue. Up to 50% of antibiotics are inappropriately prescribed, the majority of which are for acute respiratory tract infections (ARTI).ObjectiveTo evaluate the impact of unblinded normative comparison on rates of inappropriate antibiotic prescribing for ARTI.DesignNon-randomised, controlled interventional trial over 1 year followed by an open intervention in the second year.SettingPrimary care providers in a large regional healthcare system.ParticipantsThe test group consisted of 30 primary care providers in one geographical region; controls consisted of 162 primary care providers located in four other geographical regions.InterventionThe intervention consisted of provider and patient education and provider feedback via biweekly, unblinded normative comparison highlighting inappropriate antibiotic prescribing for ARTI. The intervention was applied to both groups during the second year.Main outcomes and measuresRate of inappropriate antibiotic prescription for ARTI.ResultsBaseline inappropriate antibiotic prescribing for ARTI was 60%. After 1 year, the test group rate of inappropriate antibiotic prescribing decreased 40%, from 51.9% to 31.0% (p<0.0001), whereas controls decreased 7% (61.3% to 57.0%, p<0.0001). In year 2, the test group decreased an additional 47% to an overall prescribing rate of 16.3%, and the control group decreased 40% to a prescribing rate of 34.5% after implementation of the same intervention.Conclusions and relevanceProvider and patient education followed by regular feedback to provider via normative comparison to their local peers through unblinded provider reports, lead to reductions in the rate of inappropriate antibiotic prescribing for ARTI and overall antibiotic prescribing rates.
MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
Authors: Bhuva Anish N , Feuchter Patricia , Hawkins Angela , Cash Lizette , Boubertakh Redha , Evanson Jane , Schilling Richard , Lowe Martin , Moon James C , Manisty Charlotte H 
Published: February 2019

BackgroundPatients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.AimTo deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).MethodsPatients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.Results215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.ConclusionImplementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.
Sex and intimacy in people with severe asthma: a qualitative study
Authors: Holmes Leanne Jo , Yorke Janelle A , Dutton Caroline , Fowler Stephen J , Ryan Dorothy 
Published: February 2019

IntroductionPeople with severe asthma experience unpredictable daily symptoms requiring an intense treatment regimen impacting on health-related quality of life (QoL). Sexuality contributes to this, yet there is a dearth of research exploring intimacy in people with severe asthma. We aimed to explore the patient’s perception of the impact of severe asthma on intimacy, establish their information needs and their perceived role of the healthcare practitioner.MethodsWe have performed a qualitative study guided by Interpretive Phenomenological Analysis. We interviewed patients diagnosed with severe asthma recruited from a dedicated clinic using purposive sampling. Interviews were audio recorded and transcribed verbatim. Using thematic analysis, the data were analysed for emergent themes.ResultsThe nine interviews provided unique and detailed insights into their perspectives on how living with severe asthma impinges on sexual intimacy. Four superordinate themes emerged: (1) ‘Physical intimacy’: including disclosure of physical limitations of severe asthma on intimacy; (2) ‘Emotional intimacy’: the cyclical impact of the often-negative emotional struggle of living with severe asthma on relationships; (3) ‘The role of the healthcare professional’: a perceived failure of healthcare professionals (HCPs) to tackle sexual intimacy in consultations and (4) ‘Image of self’: the reported struggle to deal with negative body image and confusion regarding changing relationship roles.DiscussionThis study is the first to explore the impact of severe asthma on intimacy. We suggest an emphasis on education to raise awareness and help HCPs to address this sensitive topic in this cohort and adopt positive strategies to help improve QoL.
Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial
Authors: Ngu Wee Sing , Bevan Roisin , Tsiamoulos Zacharias P , Bassett Paul , Hoare Zoë , Rutter Matthew D , Clifford Gayle , Totton Nicola , Lee Thomas J , Ramadas Arvind , Silcock John G , Painter John , Neilson Laura J , Saunders Brian P , Rees Colin J 
Published: February 2019

ObjectiveLow adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC).DesignPatients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured.Results1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events.ConclusionEV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection.Trial registration numberNCT02552017, Results; ISRCTN11821044, Results.